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919) The American Society for Apheresis (ASFA) periodically publishes guidelines, using an evidence based approach, regarding the use of therapeutic apheresis in clinical practice. Based on the 2013 ASFA guidelines, there are four categories describing the indications for therapeutic apheresis. Which one of the following is the best description of a category III indication by the ASFA 2013 guidelines?

Disorders for which apheresis is accepted as first-line therapy, either as a primary stand-alone treatment or in conjunction with other modes of treatment. Disordersfor which apheresis is accepted as second-line therapy, either as a stand-alone treatment or in conjunction with other modes of treatment. The optimal role of apheresis is not established; decision making should be individualized. Disorders in which published evidence demonstrates or suggests that apheresis is ineffective or harmful. Institutional review board (IRB) approval is desirable if apheresis treatment is undertaken in these circumstances. Disorders that, based on the available evidence, should never be treated with apheresis.

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• The American Society for Apheresis (ASFA) guidelines provide an important evidence-based tool for the practice of therapeutic apheresis.

• In the 2013 ASFA guidelines, the descriptions of the various categories were simplified compared with previous versions of the guidelines. Changes in these descriptions include the addition of the strength of the recommendation, which allowed categorization to be better aligned with the strength of the evidence and the quality of the relevant publications in the literature.

• The definiton of category III reflects the individual character of the decision making process for diseases in this category.

• The recommendation grade and the individual patient’s clinical circumstances should guide whether or not therapeutic apheresis is included in the treamtent plan for category III indications.

• Other professional organizations in other fields (e.g., neurology) also prepare consensus guidelines regarding the indications for therapeutic apheresis. These may not always agree with those promulgated by the ASFA.

Schwartz J, Winters JL, Padmanabhan A, et al: Guidelines on the use of therapeutic apheresis in clinical practice-evidence-based approach from the Writing Committee of the American Society for Apheresis: the sixth special issue. J Clin Apheresis 2013;28:145-284.

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Clinical Pathology: Transfusion Medicine

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