Lipoprotein apheresis, sometimes called LDL apheresis, began at Harefield Hospital in November 2000. The team now treats 23 patients in a dedicated, state-of-the-art unit, one of only three designated centres in the UK.
The unit is located at the top of the main building of the hospital. Treatments take place Monday to Thursday with three to four patients being treated each day.
The unit welcomes patients from all over the UK and has treated people from Suffolk, Devon, Sussex and Kent. There is no designated catchment area, so any patients who fulfil the criteria should be referred to Dr Barbir.
What is lipoprotein apheresis?
Lipoprotein apheresis is a type of dialysis treatment. It is an ‘extracorporeal’ (blood taken outside the body) procedure which removes low-density lipoprotein (LDL) cholesterol from the blood. This is the ‘bad’ cholesterol, high levels of which increases the risk of people developing coronary artery disease (CAD). Lipoprotein apheresis is considered for those patients who, despite the maximum amount of drug treatment and a cholesterol lowering diet, still have a high LDL cholesterol level. Many of the patients who are treated have a genetic disorder of cholesterol metabolism called familial hypercholesterolaemia (FH).
The following patients should be considered for the treatment:
- Homozygote FH patients
- Heterozygote FH patients and patients with other forms of severe hypercholesterolaemia with progressive coronary heart disease and an LDL cholesterol level which remains >5.0mmol/L
- Patients with Lp(a) levels >600mg/L
How is lipoprotein apheresis performed?
Lipoprotein apheresis circulates a portion of the blood outside the body, passes it through a special adsorber column, which removes the LDL cholesterol and then returns the treated blood back to the patient. It also removes lipoprotein (a) and triglycerides but has only minimal affect on high-density lipoprotein (HDL), the ‘good’ cholesterol. The process is very similar to renal dialysis.
The treatment involves placing two needles (cannulae) into the patient’s veins - one to remove the blood and the other to return the treated blood. It is important that we can obtain sufficient blood flow for the machine to work effectively. Usually the veins in the arms are sufficient. If there are repeated problems with the veins we occasionally suggest formation of a shunt in the arm, similar to those used in patients having renal dialysis.