Preparing for Apheresis Procedure: Low Density Lipoprotein (LDL) Removal

LDL refers to low-density lipoprotein, often referred to as “bad cholesterol.” LDL circulates through the bloodstream and collects on artery walls. Apheresis is a procedure that remove parts of the blood, in this case, the cholesterols and triglycerides. While the exact mechanism is not known, this procedure may help patients with a kidney disease called focal segmental glomerulosclerosis (FSGS) or condition called familial hypercholesterolemia.

The apheresis process involves withdrawing blood from your child, sending it through a series of filters which separate plasma from the remaining blood cells, and then removes the LDL cholesterol from the plasma. The blood and plasma are then returned to your child by their central line catheter access. Blood and fluids are slowly removed and returned to your child at the same time, so your child is never missing more than a few ounces (1 cup) of blood at a time. Your child will also receive heparin, a blood thinner, that will prevent your child’s blood from clotting during the procedure.

This procedure takes time – several hours. It will likely need to be repeated at regular intervals under the direction of your child’s provider and the apheresis team.

Though not common, LDL apheresis may have some side effects.

Your child may have:

• Nausea, vomiting, dizziness, or fainting
• Bruising, numbness, pain, or infection at the site where the catheter went in
• Low blood pressure, or blood pressure that goes up and down
• Blood loss from clotting in machine

If your child has any of these symptoms, please tell your child’s medical team.

Starting 2 to 3 days before apheresis:

• If your child is taking an (ACE) inhibitor (for example lisinopril or enalapril), tell our provider. Side effects are more common in children taking ACE inhibitors.
• Have your child stay hydrated. Liquids help keep the veins full and puffy and easier to access (if placing a needle for an IV). Ask your kidney doctor about how much liquid is OK if your child had a fluid restriction.
• Have your child eat a good meal before the procedure. The procedure is best tolerated with food in their stomach.
• Have your child dress in loose clothing (loose shirt) or short sleeves to allow for access to catheter.

• Your child will have a heart monitor line taped to their chest and will have vitals checked every half hour
• Your child will be asked to use the restroom right before the procedure. If they need to pee during apheresis, a urinal or portable potty chair (commode) is provided at bedside.
• Blood will be drawn for labs before and after the procedure using the same line used for the apheresis tubing (whether in the arm or central line).
• Your child can sleep, listen to music, watch TV, or play on an iPad during the procedure.
• We cannot disconnect your child from the machine until the end of the procedure. Your child will not be able to get up and walk around during the collection.
• It’s fine for your child to eat and drink during the procedure. Ask your nurse about the hospital room service menu and how to order.

• Your child can start their regular (light) activity and foods right away.
• Strenuous physical activities should be avoided 24 hours after your child’s treatment.

Call your primary care doctor if your child has any of the following warning signs after the procedure:

• Fever or chills
• Redness or swelling at line exit site
• Any drainage at line exit site
• Pain
• Shortness of breath or difficulty breathing — CALL 911