Lipoprotein Apheresis (LA) is a specialized, non-drug treatment designed to manage extremely high levels of fats in the bloodstream. This procedure acts as an external filtration system, similar to kidney dialysis, but specifically targets cholesterol-carrying particles. LA mechanically removes lipoproteins from the blood when conventional methods, such as diet changes and maximum tolerated medications, have proven insufficient. This therapy is typically reserved for individuals with severe, inherited lipid disorders who face a heightened risk of premature cardiovascular events.
Conditions Treated by Lipoprotein Apheresis
This filtering therapy is primarily indicated for patients with severe, genetic forms of high cholesterol resistant to standard drug regimens. The most common indication is Familial Hypercholesterolemia (FH), an inherited condition where genetic mutations impair the body’s ability to clear Low-Density Lipoprotein cholesterol (LDL-C). For these patients, LDL-C levels remain dangerously elevated, increasing the risk of heart attack and stroke.
Apheresis is used when an individual’s LDL-C remains above specific thresholds despite maximum tolerated doses of statins, ezetimibe, and newer agents like PCSK9 inhibitors. When pharmacological intervention alone cannot achieve the necessary reduction, the procedure provides an immediate, substantial reduction in the circulating burden of atherogenic lipoproteins.
Patients also qualify for LA due to severely elevated levels of Lipoprotein(a) or Lp(a), a distinct particle associated with progressive cardiovascular disease. Lp(a) levels are largely determined by genetics and are difficult to lower using standard cholesterol-lowering medications. For individuals with high Lp(a) and established heart disease, LA is one of the few available therapies that can significantly reduce this specific risk factor.
Understanding the Treatment Process
The Lipoprotein Apheresis procedure is an extracorporeal treatment, meaning blood is circulated outside the body through a dedicated machine. The session begins by establishing vascular access, typically placing two needles or cannulas in the patient’s arm veins. If suitable peripheral veins are difficult to access, a permanent option like a surgically created arteriovenous fistula or a central venous catheter may be required for reliable long-term use.
Once connected, the machine draws blood through one line and passes it through a specialized system. Plasma separation occurs inside the machine, dividing the whole blood into its liquid component (plasma) and cellular components (such as red and white blood cells). The cellular components are temporarily held while the plasma, which contains the lipoproteins, continues through the circuit.
The separated plasma is directed into a column containing material designed to bind to or filter out the atherogenic lipoproteins, specifically LDL and Lp(a). This filtration step selectively removes the cholesterol particles while leaving most other plasma proteins intact. After removal, the cleaned plasma is recombined with the patient’s blood cells and returned to the body through the second access line. The entire process is continuous and automated, with the machine carefully maintaining blood volume and fluid balance. A single treatment session typically lasts between two and four hours, depending on the patient’s blood volume and the specific machine used.
Treatment Frequency and Long-Term Management
Lipoprotein Apheresis is not a cure, as the body’s underlying metabolic issue continues to produce high levels of lipoproteins, requiring regular, scheduled treatments. Since LDL-C and Lp(a) levels begin to rebound almost immediately after a session, the therapy is typically performed on a chronic basis. The most common frequency is once every one to two weeks to ensure time-averaged lipoprotein levels remain low enough to protect against cardiovascular damage.
LA is an indefinite, often lifelong, therapy for most patients, unless they undergo a rare curative intervention such as a liver transplant. Patients must integrate these scheduled sessions into their daily lives, often requiring a half-day or full day off from work or school every treatment cycle. Treatment is generally well-tolerated, and specialized nurses closely monitor patients throughout the session.
While considered safe, the procedure can cause mild, transient side effects related to the rapid removal of blood components and the use of anticoagulants. These effects may include temporary hypotension, mild nausea, light-headedness, or fatigue. Patients must avoid taking certain blood pressure medications, such as ACE inhibitors, on the day of the procedure, as this combination significantly increases the risk of severe hypotension. Patients are also advised to avoid strenuous activity for the remainder of the treatment day due to the need for blood thinning during the process.