• MA03
  • DX21
  • Dali
  • Life 18
  • H.E.L.P.
  • Double Filtration
LDL - What can I do during the treatment?
During treatment...

Try to relax!

During your treatment you will either be sitting or reclining in a chair or lying on a bed. We will chat to you during your treatment or you may want to bring a book to read or some music to listen to. Alternatively you may want to watch TV or a video to help pass the time.

LDL Apheresis Toolkit

HEART UK Lipoprotein Apheresis Toolkit

A toolkit to inform clinicians, patients and commissioners about lipoprotein apheresis treatment.

View the toolkit »

LDL Apheresis treatment FAQs

There are a variety of machines which can be used for LDL-apheresis. The team carrying out your treatment will decide which is the best one for you. Some people get on better with one machine rather than another. It generally doesn’t matter which machine is used, as they are all very effective at reducing LDL cholesterol.

Click on the questions below to understand more about the types of treatment and how they affect you.

Q

What is Whole blood treatment?

A

This is probably the most common type of LDL-apheresis treatment used in the UK. The LDL cholesterol, Lp(a) and triglycerides are removed from the blood without the need to separate the blood into red cells and plasma. This means that the treatment is generally slightly shorter.

There are 2 companies which make whole blood apheresis machines:

Kaneka which makes the DX21 machine and Fresenius Medical Care which makes the DALI machine.

Q

What is Plasma treatment?

A

There are several methods of LDL-apheresis which involve removing the LDL cholesterol from the plasma. When the treatment was first developed, this was how it was done. LDL cholesterol Lp(a) and triglycerides are found in the plasma. This type of treatment involves the separation of the blood into red cells and plasma and then just the plasma is directed to the specialised absorption column.

Today there are 2 companies which make this type of machine: Kaneka which makes the MA03 machine and Miltenyi-Biotec which makes the Life 18 machine.

Q

What are the other methods of LDL-apheresis?

A

Plasmat Futura HELP Machine

The H.E.L.P apheresis unit stands for Heparin Extrocorporeal LDL Precipitation. Plasma is separated in the first step of the procedure.  The blood components are directly reinfused to the patient together with the returned treated plasma.  The plasma is mixed with the heparin which precipitates LDL, Fibrinogen and Lp(a) which is then filtered out.  Cardiff has the only HELP machine in the UK however it is used on a large scale in Europe and the US.

Double Filtration

The double filtration machine uses highly biocompatible single use filters and tubing sets. Depending on the treatment being carried out, first plasma is separated by filtration and is then either removed and replaced by substitution fluid (plasma exchange) or passed through a second filter called a fractionator (Double Filtration). The fractionator used depends on what needs to be removed. Treated plasma is then reunited with the red cells and returned to the patient.

Double filtration is used in the apheresis units in Harefield, Hammersmith and Nottingham.

Both of the machines do not cause patients to have a histamine release called "Bradykinen" hence patients on these machines are able to take ACE inhibitor medication unlike the other LDL-apheresis machines discussed.

Q

How is LDL-apheresis performed?

A

LDL-apheresis is very similar to kidney dialysis. The treatment involves placing two needles (cannulae) into your veins - one to remove the blood and the other to return the treated blood to you. Usually the veins in the arms are sufficient for us to obtain the required blood flow. However if there are repeated problems with the veins we suggest you have a special ‘shunt’ formed in the arm, similar to those used in patients having kidney dialysis.

Blood is gently drawn into the machine by a pump and it is mixed with an anticoagulant to stop it clotting in the machine. The blood is passed through a special absorber column where the LDL cholesterol is removed. The ‘clean’ blood is then return to you. The column also removes lipoprotein (a), which is similar to LDL cholesterol and triglycerides - another lipid in the blood - but has only a small effect on the high density lipoprotein (HDL) which is the ‘good’ cholesterol.

Q

How will I feel during the treatment?

A

It is sometimes a bit uncomfortable when the needles are placed in your arms but you can be given some local anaesthetic cream to apply before you come for your treatment which can help. Generally the treatment is carried out with no problems.

This treatment has been available for over 20 years and has been shown to be both safe and effective. Occasionally people can have slight reactions to the treatment. These include;

  • Light headedness
  • Low blood pressure
  • Nausea
  • Headache
  • Feeling cold
  • Flushed feeling

These reactions are not common and can generally be treated quickly. Some of these symptoms are not uncommon for the first few treatments but most people gradually acclimatise to the treatment in time. Patients often complain of feeling tired after the treatment and possibly a bit irritable. We therefore advise you to rest as much as you can after the treatment.

Q

What can I do to minimise the reactions to treatment?

A
  • Please do not have your treatment on an empty stomach. Make sure you eat and drink enough before we start your treatment. You may also eat and drink during the treatment if you want to.
  • Do not drink alcohol during the 24 hours before your treatment.
  • Do not take beta blocking tablets on the day of your treatment (e.g. Atenolol, Propanolol, Metoprolol, Bisoprolol) or any other medication to lower your blood pressure. Please continue your medication as normal the following day.
  • Try to avoid activities which increase the risk of physical injury for 24 hours after your treatment due to the blood-thinning medication used.
  • Rest for the remainder of the day following your treatment.
  • ACE inhibitor medication cannot be taken by most people undergoing LDL-apheresis (medication such as Ramipril, Lisinopril, Perindopril) as these can react with the substances in the absorber column. If a doctor suggest starting any of these medications, please ask him/her to contact your apheresis unit.
  • Is there anything I should do before the treatment?
  • Drink plenty of fluids and eat a light meal.
  • Visit the toilet! You will be lying still during the treatment and will not be able to go to the toilet until the treatment is completed.
  • Wear light comfortable clothing. We will need access to your arms, so short sleeves are a good idea.
  • If your medication changes please tell us before you start your next treatment.
  • Try to arrive as relaxed as possible. Rushing to the unit and feeling stressed is not the best way to start so leave plenty of time and avoid making arrangements for after your treatment in case there is an unavoidable delay with your treatment.
Q

Is there anything I should do before the treatment?

A
  • Drink plenty of fluids and eat a light meal.
  • Visit the toilet! You will be lying still during the treatment and will not be able to go to the toilet until the treatment is completed.
  • Wear light comfortable clothing. We will need access to your arms, so short sleeves are a good idea.
  • If your medication changes please tell us before you start your next treatment.
  • Try to arrive as relaxed as possible. Rushing to the unit and feeling stressed is not the best way to start so leave plenty of time and avoid making arrangements for after your treatment in case there is an unavoidable delay with your treatment.
Q

How long will the treatment take?

A

This depends on how fast we can run the machine which in turn depends on your veins. Your LDL level and body size will help us determine how much blood we need to treat. Generally treatments take between 2-4 hours but may be slightly longer. Most people come for treatment every 2 weeks but sometime we recommend that you have treatment every week. The first few treatments tend to take a bit longer as we get you used to the treatment.

Q

How does the treatment affect my LDL cholesterol levels?

A

Each treatment can lower your LDL cholesterol level by 50-65%. However this reduction in cholesterol does not remain over time. This is because your raised LDL cholesterol level is the result of an underlying metabolic problem and the treatment does not correct this. The LDL cholesterol level will begin to increase immediately after the treatment. This is why the treatments need to be carried out every 2 weeks or every week.

In order to get the best reduction in the LDL cholesterol level, the treatments need to be performed regularly. There is evidence that continued LDL-apheresis treatment can reduce the risk of future cardiovascular problems and that the progression of arterial disease can be substantially slowed.

Treatment is life-long and you must continue to take your lipid lowering medication and stick to a low fat diet.

Q

What blood tests will I have done?

A

Treatment is carried out on an outpatient basis so you should be able to go home fairly soon after your treatment has been completed.  Before discharge your needles sites will be assessed and a dressing applied.  Unless you live very close to your treatment centre, we do not advise you to drive home. You will definitely not be able to drive for the first few treatments whilst you are getting used to the treatment.

Q

Lipoprotein Apheresis; Who should we treat?

A

Lipoprotein apheresis has been available as a treatment since the late 1980’s in this country and many studies have proven its efficacy in reducing cholesterol levels albeit temporarily. Despite this, there remains scarce provision of the service throughout the UK which is in stark contrast with Europe.

There are currently only 4 designated Lipoprotein apheresis centres in the UK; Harefield Hospital, Hammersmith Hospital, Llandough Hospital in Cardiff and Manchester Royal Infirmary. There are a further 4 places providing apheresis treatment, 2 Blood Transfusion Centres in Leeds and Bristol, a renal unit in Queen Elizabeth Hospital, Birmingham and a children’s unit at Nottingham Hospital.

The numbers of patients receiving treatment at the moment are as follows

Harefield: 23, Hammersmith: 6, Llandough: 18, Leeds: 2, Bristol: 6, Birmingham: 5, Manchester: 9 


As you can see there are about 70 patients currently receiving lipoprotein apheresis but according to Dr. G. Thompson it is calculated that approximately 200 patients should be receiving treatment if the criteria set out by the HEART-UK LDL apheresis Working Group were to be applied. This group published the following guidelines on indications for LDL apheresis treatment.

  • Homozygous (including compound heterozygous) FH patients with extreme hypercholesterolaemia from childhood.
  • Heterozygous FH with poor family history with evidence of significant progression of coronary heart disease and whose LDL remains >5.0mmol or decreases by <40% despite combination therapy.
  • Patients with progressive CHD, severe hypercholesterolaemia and LPa >60mg/dl. Whose LDL remains significantly elevated despite drug therapy.

These guidelines produced by HEART UK were then followed by NICE guidance on FH which recommended that you should…

“Consider offering LDL Apheresis for the treatment of adults and children/young people with clinical homozygous FH……”

and

“In exceptional instances (such as when there is progressive, symptomatic coronary heart disease, despite maximal tolerated lipid – modifying drug therapy and optimal medical and surgical therapy) consider offering LDL apheresis for the treatment of people with heterozygous FH.”

At Harefield Hospital we take patients for apheresis treatment from all over the country as long as they are happy to travel. We have treated patients from Suffolk, Devon Sussex and Kent. There is no catchment area as such, any patients who fulfil the criteria above should be referred to Dr Barbir, Consultant Cardiologist, who will refer them to Alison Pottle, Cardiology Nurse Consultant, who will invite them to visit the unit and discuss the treatment.

The greatest challenge for those working in Lipoprotein Apheresis at the moment is the identification of those eligible patients and this will only be achieved by raising awareness amongst health professionals. A website has been set up in conjunction with HEART UK to provide information to patients and health professionals for this purpose.

LDL - Case studies
Case studies

To be able to read about someone who has LDL apheresis on a regular basis, may help others considering it.

 
LDL - Find a unit
Find a unit

Use our clickable map to help you locate your nearest Lipid Clinic and Apheresis Unit within the UK.

 
LDL-apheresis therapy
LDL-Apheresis therapy

"LDL-Apheresis therapy can help patients achieve safe reductions of low density lipoprotein cholesterol (LDL-C) levels"