AM23-SN-24-O: The Road Not Taken: Data-Driven Reasons to Decline a Request for Therapeutic Apheresis (Enduring)

Transfusion medicine (TM) practitioners often manage busy apheresis services, performing complex clinical consultations. Referring providers are typically specialists in another medical discipline, such as neurology, hematology, or oncology, who may be contemplating the potential role that apheresis may have in managing a complex clinical situation. Although some specialty society guidelines exist, each consultation is ultimately a patient-specific evaluation, and the decision to perform, or to decline to perform, an apheresis procedure ultimately rests with the TM service.Unfortunately, many apheresis/TM practitioners experience extreme pressure to agree to perform apheresis procedures for which their medical valuation of patient-specific risks, recent literature, and theoretical procedural benefits favors holding off on apheresis. The lack of well-controlled clinical trials in this area can make declining a request for a procedure difficult. Our session is an opportunity to both share data and offer reassurance to apheresis/TM providers who may feel alone or unsupported if they recommend against performing an apheresis procedure when consulted.We set the stage by sharing two years of therapeutic apheresis “consultations without procedures” data from a major academic medical center and will engage the audience using an interactive response format. We analyze recent literature focusing on plasmapheresis for hypertriglyceridemia and neurologic diseases, highlighting areas that are still “data-free zones”. Our second speaker shifts the focus to red cell exchange, sharing their experience with non-apheresis-based management of babesiosis. We extend this conversation beyond the academic medical center to explore the challenges facing organizations that offer “remote” or “contracted” apheresis services, which provide important apheresis opportunities to patients in the community who may otherwise not have access to these technologies.