What is LDL Apheresis?

LDL apheresis is quite safe and well tolerated, but some undesirable effects and adverse reactions can occur.  Although the removal of LDL is selective, other important components of the plasma such as HDL, platelets, and vitamin E may be inadvertently removed to a lesser degree.   Some red blood cells that are run through the plasma separator may become damaged.  This, in turn, may contribute to anemia.  The most significant adverse reaction from the treatment is hypotension.  Apheresis can withdraw a significant amount of blood volume from a person, and even though most of it is returned, this still may cause a drop in blood pressure.  Adequate hydration and the avoidance of blood pressure medication prior to treatment can help minimize this risk.  Other more serious events such as a heart attack, air embolism, or death are quite rare.

Given the above information, the Food and Drug Administration has approved the use of LDL apheresis in three categories of patients in the US who have failed both diet and maximum medical therapy:  1) FH homozygotes with LDL >500mg/dl, 2) FH heterozygotes with LDL>300mg/dl, and 3) FH heterozygotes with LDL>200mg/dl and a documented history of heart disease.  It is important to remember that apheresis is not a replacement therapy but rather a complement to lifestyle modifications and medicine.   Future areas of research include assessing the benefit of this technology in treating those with heart disease and no documented genetic familial hypercholesterolemia.