Lipoprotein apheresis, sometimes called LDL apheresis, began at Harefield Hospital in November 2000. The team now treats 37 patients in a dedicated, state-of-the-art unit, one of eight designated centres in the UK.
The unit is located at the top of the main building of the hospital. Treatments take place Monday to Friday with three to five 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 an only minimal effect 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 the formation of a shunt in the arm, similar to those used in patients having renal dialysis.
Systems of apheresis
There are several different systems available for lipoprotein apheresis. The unit currently uses the Kaneka DX21 system, which removes the cholesterol from the whole blood, and the L.IN.C Medical HF440 machine, which works by first separating the red cells from the plasma and then removing the cholesterol from the plasma. We aim to achieve a 50 to 60 per cent reduction in LDL cholesterol with each treatment, however, the reduction does not remain over time, therefore patients need to treated every one to two weeks. Each treatment lasts between two to three hours. The treatment is generally tolerated well and has few side effects.
The apheresis team
For more information
You can read more about our lipoprotein apheresis unit, based at Harefield Hospital.