Transfusion medicine (TM) practitioners often manage busy apheresis services, performing complex clinical consultations. Referring providers are typically specialists in another medical discipline, such as neurology, hematology, or oncology, who may be contemplating the potential role that apheresis may have in managing a complex clinical situation. Although some specialty society guidelines exist, each consultation is ultimately a patient-specific evaluation, and the decision to perform, or to decline to perform, an apheresis procedure ultimately rests with the TM service.Unfortunately, many apheresis/TM practitioners experience extreme pressure to agree to perform apheresis procedures for which their medical valuation of patient-specific risks, recent literature, and theoretical procedural benefits favors holding off on apheresis. The lack of well-controlled clinical trials in this area can make declining a request for a procedure difficult. Our session is an opportunity to both share data and offer reassurance to apheresis/TM providers who may feel alone or unsupported if they recommend against performing an apheresis procedure when consulted.We set the stage by sharing two years of therapeutic apheresis “consultations without procedures” data from a major academic medical center and will engage the audience using an interactive response format. We analyze recent literature focusing on plasmapheresis for hypertriglyceridemia and neurologic diseases, highlighting areas that are still “data-free zones”. Our second speaker shifts the focus to red cell exchange, sharing their experience with non-apheresis-based management of babesiosis. We extend this conversation beyond the academic medical center to explore the challenges facing organizations that offer “remote” or “contracted” apheresis services, which provide important apheresis opportunities to patients in the community who may otherwise not have access to these technologies.
Describe the prevalence of “declined apheresis consultations” at a major academic medical center, by diagnosis and patient outcomes
Highlight recent literature supporting patient-specific decisions to avoid plasmapheresis in hypertriglyceridemia and selected neurologic conditions
Outline selective decisions in applying red cell exchange transfusion to babesiosis, and share an institutional experience when a selective approach is employed.
Contrast decision-making strategies of bedside hospital-based transfusion medicine consultations with remote, contracted service-based apheresis operational paradigms.
Gauge how one’s own practice patterns regarding declining apheresis consultations compares with other TM/apheresis providers through session polls using Poll-Everywhere®-type technology to create a safe space to anonymously and openly address difficult clinical apheresis conundrums.
Executive Physician Director, Therapeutic & Cellular Solutions,
American Red Cross
Medical Director, Blood Transfusion Service, Patient Services and Apheresis Clinic,
Massachusetts General Hospital
Associate Professor of Pathology and Laboratory Medicine,
Rhode Island Hospital, Brown University