Leukapheresis: What It Is, How It Works, Uses, Risks and Recovery
Updated: 3 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick Answer
What is leukapheresis? Leukapheresis is a blood-processing procedure that removes white blood cells and returns the remaining blood to the bloodstream. It may be used when very high or rapidly multiplying white blood cells cause symptoms, and to collect stem cells or certain immune cells, such as for CAR T-cell therapy. It does not cure leukemia or other blood disorders. [1]
What the research says
In AML, leukapheresis has not shown a clear short-term survival benefit. Up to 20% of people with acute myeloid leukemia (AML) present with hyperleukocytosis (white blood cells above 100 × 10⁹/L). In a meta-analysis of 13 retrospective studies (1,743 patients; 486 with leukapheresis and 1,257 without), leukapheresis did not reduce early death (risk ratio 0.88, 95% CI 0.69–1.13), and the authors argued against routine use in AML (Bewersdorf et al., Transfusion, 2020; DOI). [2]
The evidence for any single emergency approach is limited. A review of hyperleukocytosis and leukostasis in acute and chronic leukemias concluded that data supporting any specific cytoreductive approach, including hydroxyurea, corticosteroids, chemotherapy and leukapheresis, are limited, so practice is guided mainly by expert opinion (Macaron et al., Leukemia & Lymphoma, 2022; DOI). [3]
It lowers white blood cell counts quickly and is generally well tolerated. A clinical review describes leukapheresis as removing excess white blood cells rapidly, correcting metabolic abnormalities and easing the symptoms of leukostasis, and as an adjuvant option for patients who are not suitable for cytoreduction with cytarabine or hydroxyurea (Zhang et al., International Journal of General Medicine, 2021; DOI). [4]
Key Takeaways
Feature | Details |
What It Is | A procedure that removes white blood cells from blood and returns the rest |
Main Uses | Reducing very high white blood cell counts; collecting stem cells or immune cells |
Session Length | At least two to three hours, up to a few hours |
Access | Two arm IVs, or a central line near the neck or under the collarbone |
Possible Side Effects | Low calcium, anemia, low platelets |
After Treatment | Take it easy for the first day or so |
Important Limit | Does not cure blood disorders or blood cancer |
What Is Leukapheresis?
Leukapheresis is a procedure that removes white blood cells from blood. The healthcare team takes blood from your bloodstream and processes it so white blood cells are separated from red blood cells, plasma and platelets. The blood is then returned to your bloodstream. [1]
The goal is not to remove every white blood cell. The procedure is used in specific situations, such as an unusually high or rapidly multiplying white blood cell population or a planned stem-cell collection. Leukapheresis does not cure blood disorders or blood cancer, and providers typically combine it with other treatments. [1]
Why Is Leukapheresis Used?
Healthcare providers may recommend leukapheresis to ease symptoms caused by abnormal white blood cells multiplying uncontrollably, and to collect blood or bone marrow stem cells to help rebuild bone marrow after chemotherapy for certain blood cancers. [1]
Reason | What leukapheresis may do |
Some acute or chronic leukemias | May be recommended as an initial treatment for acute myeloid leukemia, acute lymphocytic leukemia or chronic lymphocytic leukemia when your provider considers it appropriate. |
Very high white blood cell count | May reduce white blood cells that are clogging the bloodstream and raising the risk of heart trouble. |
Treatment needing healthy white blood cells | May collect cells before a treatment such as CAR T-cell therapy. |
Stem cell or bone marrow transplant | May collect cells used in treatment for certain lymphomas or multiple myeloma. |
Donation | May collect stem cells from a donor for someone being treated for certain leukemias. |
Your diagnosis, blood-cell levels, planned treatment and overall condition determine whether leukapheresis is appropriate. Only your treating team can make that decision for you.
How do you prepare for leukapheresis?
Preparing for leukapheresis may involve blood tests and other checks, plus comfortable clothes and something to read or watch during the session.
Because a session can take up to a few hours, wear comfortable clothes and bring something to read or watch. [1]
What happens during the leukapheresis procedure?
Your healthcare provider makes you comfortable in a bed and places two intravenous (IV) lines in your arms. One line removes blood, and the other returns it to your bloodstream. Sometimes a single large catheter called a central line, placed near the neck or under the collarbone, contains both IVs. [1]
Blood moves through a processing system that separates white blood cells from red blood cells, plasma and platelets, and the processed blood is returned. A session may take at least two to three hours. [1]
Stage | What happens |
Positioning | You rest comfortably in a bed. |
Vascular access | Two arm IVs are used, or a central line contains both IVs. |
Blood removal | One line takes blood from your bloodstream. |
Separation | The system separates white blood cells from red blood cells, plasma and platelets. |
Blood return | The processed blood returns to your bloodstream. |
Monitoring | The team watches for symptoms and manages effects such as low calcium. |
What You Might Feel
Some people notice numbness or tingling in the hands, feet or around the mouth. These are signs that calcium levels are dropping, and your provider can add calcium to the IV to manage them. Tell your team about any new or uncomfortable symptoms during the session. [1]
What happens after leukapheresis?
After treatment, your provider monitors you for signs of low blood volume and other side effects and may take blood tests. Depending on the results, they may recommend a blood transfusion to replace red blood cells and platelets. [1]
Leukapheresis is usually one part of a larger plan. When collecting stem cells, you may need several sessions to reach a target number of cells. Plan to take it easy for the first day or so, and follow your team’s instructions about activity, food, fluids, medicines and your next appointment. [1]
What are the potential advantages of leukapheresis?
Leukapheresis can quickly lower the number of white blood cells when very high levels cause serious symptoms, which may allow your provider to begin other treatments. It can also collect bone marrow stem cells to help bone marrow recover after high-dose chemotherapy for certain blood cancers, and certain immune cells for a treatment such as CAR T-cell therapy.
These are potential roles, not a guarantee of benefit. In AML with a very high white blood cell count, studies have not shown a clear short-term survival benefit, which is why your hematology team weighs it against other options. It is an additional treatment and does not cure the underlying disease. [2]
What are the possible side effects of leukapheresis?
Serious side effects from leukapheresis are rare, but the most often listed ones are hypocalcemia, anemia and thrombocytopenia. The side effects listed most often are:
Hypocalcemia
Hypocalcemia means lower-than-normal calcium in the blood. The leukapheresis process may remove calcium. Numbness or tingling can occur, and your provider can treat it with intravenous calcium. [1]
Anemia
Anemia means there are not enough red blood cells or they are damaged. The process can sometimes cause red blood cell loss, so your team monitors your blood counts. [1]
Thrombocytopenia
Thrombocytopenia means low platelet levels. Platelets help blood clot, so low levels may cause unusual or excessive bleeding. [1]
When should you call your healthcare provider during leukapheresis treatment?
During leukapheresis treatment, call your provider for a fever of 100.4°F (38°C), redness, drainage or pain at the central line site, or symptoms that worsen or change. Call your provider any time you have:
Do not wait for an article to interpret a line problem. Use the contact and emergency instructions from your treating team.
What questions should you ask before leukapheresis?
Topic | Example question |
Purpose | Is leukapheresis being used to reduce white blood cells, collect stem cells or collect immune cells? |
Treatment plan | Which other treatments will be used with it? |
Testing | Which blood-cell, electrolyte, kidney, liver or coagulation results matter for my session? |
Access | Will I have two arm IVs or a central line? |
Duration | How long is my planned session? |
Symptoms | What should I report during treatment, including numbness or tingling? |
Calcium | How will low calcium be monitored and managed? |
Blood counts | Could a transfusion be needed after treatment? |
Number of sessions | How will the team decide whether I need another session? |
Recovery | How long should I take it easy afterward? |
Line care | Which redness, drainage or pain at the central line site should prompt a call? |
Worsening symptoms | Who should I call if symptoms change or get worse? |
Conclusion
Leukapheresis is a blood-processing procedure that removes white blood cells and returns the processed blood to the bloodstream. It may be used to ease symptoms caused by abnormally high or rapidly multiplying white blood cells, or to collect stem cells or immune cells for other treatments. A session uses two arm IVs or a central line, takes at least two to three hours, and your team monitors for low calcium, low blood volume and other side effects. It does not cure blood disorders or blood cancer, and in AML its benefit for short-term survival has not been clearly shown. Before treatment, ask your hematology team why it is being recommended, what access will be used, how long it will take, whether more sessions may be needed and which warning signs need a call.
Frequently Asked Questions
What does leukapheresis remove?
It removes white blood cells from blood by separating them from red blood cells, plasma and platelets. The rest of the blood is returned to your bloodstream.
Is leukapheresis the same as chemotherapy?
No. Leukapheresis is a blood-processing procedure, not a drug treatment. Providers typically combine it with other treatments.
Does leukapheresis cure leukemia?
No. It may quickly reduce very high white blood cell levels or collect cells for another treatment, but it does not cure blood disorders or blood cancer.
Why might someone with leukemia need leukapheresis?
Providers may recommend it as an initial treatment for some people with acute myeloid leukemia, acute lymphocytic leukemia or chronic lymphocytic leukemia, especially when very high white blood cell counts are clogging the bloodstream.
What is hyperleukocytosis?
A very high white blood cell count, usually defined as more than 100 × 10⁹/L, which occurs in up to 20% of people with acute myeloid leukemia at diagnosis.
Does leukapheresis improve survival in AML?
A meta-analysis of 13 retrospective studies found no clear short-term survival benefit (risk ratio of early death 0.88, 95% CI 0.69–1.13), so it is not used routinely for everyone. Your hematology team decides based on your situation.
Can leukapheresis be used for stem cell collection?
Yes. It can collect blood or bone marrow stem cells for certain transplant plans or to help rebuild bone marrow after high-dose chemotherapy for certain blood cancers.
Can leukapheresis collect immune cells?
Yes. It may collect certain immune cells for a treatment such as CAR T-cell therapy.
How long does a leukapheresis session take?
At least two to three hours, and up to a few hours.
What access is used?
Two IV lines may be placed in the arms. Sometimes a single central line near the neck or under the collarbone contains both IVs.
What does numbness or tingling mean?
Numbness or tingling in the hands, feet or around the mouth may signal that calcium levels are dropping. The provider may add calcium to the IV.
Will I need a blood transfusion?
After treatment, your provider may take blood tests and may recommend a transfusion to replace red blood cells and platelets, depending on the results.
Will I need more than one treatment?
Possibly. Several sessions may be needed when collecting stem cells to reach a target. Your team decides based on your treatment plan and results.
What should I do after leukapheresis?
Plan to take it easy for the first day or so and follow your treating team’s instructions.
What are the most common side effects?
Low calcium (hypocalcemia), anemia and low platelets (thrombocytopenia).
What is thrombocytopenia?
A low platelet level. Because platelets help blood clot, low levels may cause unusual or excessive bleeding.
When should I call my healthcare provider?
Call for a fever of 100.4°F (38°C), redness, drainage or pain at a central-line site, or symptoms that get worse or change.
Related Reading
Apheresis: Understanding the Process, Types, and Medical Uses explains how apheresis separates blood parts and when it is used.
High White Blood Cell Count (Leukocytosis): Causes and Management covers what causes a high white blood cell count and how it is managed.
CAR T-Cell Therapy: How It Works, Side Effects, and Recovery describes how collected immune cells are changed to fight cancer.
Acute Myeloid Leukemia (AML): What It Is, Who Gets It, and How It Is Treated explains acute myeloid leukemia, its symptoms and treatment options.
References
Cleveland Clinic. Leukapheresis: Procedure, Uses Types & What It Is. Cleveland Clinic Health Library. Last updated May 2, 2022. https://my.clevelandclinic.org/health/treatments/22926-leukapheresis
Bewersdorf JP, Giri S, Tallman MS, et al. Leukapheresis for the management of hyperleukocytosis in acute myeloid leukemia: a systematic review and meta-analysis. Transfusion. 2020;60(10):2360-2369. PMID: 32776542. https://doi.org/10.1111/trf.15994
Macaron W, Sargsyan Z, Short NJ. Hyperleukocytosis and leukostasis in acute and chronic leukemias. Leukemia & Lymphoma. 2022;63(8):1780-1791. PMID: 35357988. https://doi.org/10.1080/10428194.2022.2056178
Zhang D, Zhu Y, Jin Y, et al. Leukapheresis and hyperleukocytosis, past and future. International Journal of General Medicine. 2021;14:3457-3467. PMID: 34285568. https://doi.org/10.2147/IJGM.S321787
Disclaimer
The information provided in this article is for educational purposes only and is not intended as medical advice. Always seek the advice of a qualified healthcare provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this article.
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