Most patients with high cholesterol levels can be treated using a combination of diet, exercise and drugs. Some patients who have dangerously high cholesterol, however, do not respond to strong drug treatments. Until recently, when low-density lipoproteins (LDL) apheresis became generally available, these patients had no treatment option.
Cedars-Sinai Medical Center now has the first LDL apheresis program in California, providing the needed treatment for many patients who have no other alternative.
LDL refers to what is known as the "bad" cholesterol. The LDL apheresis procedure is like kidney dialysis. Blood is continually removed from a patient's vein and run through a machine that separates out the plasma. While the rest of the blood is passed back to the patient through a different vein, the plasma is run through another part of the machine that removes the LDL in the plasma. Thus, the blood is "cleaned" of the bad cholesterol.
The results of this procedure can dramatically reduce the LDL levels and help the patient avoid heart attack and stroke. The procedure takes about two to four hours and must be repeated every two to three weeks.
Cedars-Sinai has a multi-disciplinary team of experts from cardiology and pathology and laboratory medicine, who are experienced in LDL apheresis and are equipped to handle patients in need of the procedure:
- Prediman K. (PK) Shah, MD, FACC, FACP, FCCP, Director, Division of Cardiology; Director, Atherosclerosis Research Center
- Ellen Klapper, MD, Co-Director, Transfusion Medicine
- Samuel Pepkowitz, MD, Co-Director, Transfusion Medicine
How the Procedure Works*
- The patient's blood is withdrawn via a venous access and enters the plasma separator. As blood flows through the hollow fibers of the plasma separator, the plasma is separated and pumped into one of the two LDL adsorption columns. As the plasma passes through the column, the apolipoprotein B-containing lipoproteins - LDL, Lp(a) and VLDL - are selectively adsorbed by the dextran sulfate - cellulose beads within the column. There is minimal effect on other plasma components such as HDL and albumin.
- The LDL-depleted plasma exits the column and is recombined with the blood cells exiting the separator, all of which is returned to the patient via a second venous access.
- When the first column has completed adsorbing LDL, the computer-regulated machine automatically switches the plasma flow to the second column.
- The plasma remaining in the first column is returned to the patient. The column is then regenerated, eluting the LDL, Lp(a) and VLDL to the waste lines. After elution the column is reprimed completely and ready for the next cycle of adsorption, allowing continuous LIPOSORBER treatment. A typical treatment takes two to four hours and must be repeated every two to three weeks.
*This information is reprinted with permission from Kaneka, 2004.