Red cell apheresis: pros and cons

Abstract

The collection of red blood cells ( RBC ) by apheresis, first developed in the 1970's for therapeutic use, for many years was not considered suitable for obtaining blood components for transfusion because of concerns on donor safety and elevated costs compared to whole blood ( WB ) donation. Single‐dose RBC apheresis as a part of multicomponent collections and double‐dose RBC (2 RBC ) apheresis for autologous and allogeneic transfusions were approved by the FDA between 1995 and 1997, and in Europe starting from 2000. The widespread implementation of these procedures followed mainly to address blood supply issues, as large numbers of blood components can be rapidly obtained. However, this potential advantage has been only partially confirmed in real practice, with striking regional differences. Limitations of 2RBC collections regarding both blood supply and donor safety have emerged. In particular, donor motivation, iron deficiency and risk of anaemia are issues that need to be addressed. On the other side, 2 RBC apheresis represents a valuable alternative to WB collection for autologous or dedicated donations, can reduce the risk of alloimmunization in chronically transfused patients and can facilitate transfusion support in specific cases (i.e. patients with multiple alloantibodies or rare blood groups). Reducing patient exposure to different donors can also be relevant for preventing the transmission of blood‐borne infections.