Current status of hemapheresis in the United States.

The face of automated hemapheresis in the United States is changing. No longer is it appropriate to view hemapheresis primarily in terms of therapeutic plasma exchange. For many centers, the bulk of day-to-day activities revolves around donor cytapheresis to satisfy the ever-increasing need for units of platelet concentrates. Indications of therapeutic plasma exchange are becoming better focused, with neurological patients being among those most frequently managed. New and innovative applications of automated hemapheresis technology will continue to be developed. Current examples include the production of lymphocyte-activated leukocytes for cancer therapy, use of extracorporeal photoactivation of leukocytes for immune modulation, and the collection of hematopoietic progenitors from peripheral blood for autologous transplantation. As we enter the 1990s, it is important to be aware of new technology and applications and to have the vision to apply them in innovative ways. However, it is also critical to demand rigorous scientific review before broadly adopting any new idea as a standard of practice.