an ASFA Category (I – IV). The quality and strength of evidence are denoted by standard GRADE recommendations. ASFA Categories are defined as follows: Category I for disorders where therapeutic apheresis is accepted as a first line treatment, Category II for disorders where therapeutic apheresis is accepted as a second-line treatment, Category III for disorders where the optimal role of therapeutic apheresis is not clearly established and Category IV for disorders where therapeutic apheresis is considered ineffective or harmful. Diseases and disorders Only diseases (or mentioned special conditions thereof) with ASFA category I or II are displayed in bold, with category I being underlined in addition. Fluid replacement during apheresis When an apheresis system is used for therapy, the system is removing relatively small amounts of fluid (not more than 10.5 mL/kg body weight). That fluid must be replaced to keep correct intravascular volume. The fluid replaced is different at different institutions. If a crystalloid like normal saline (NS) is used, the infusion amount should be triple what is removed as the 3:1 ratio of normal saline for plasma is needed to keep up oncotic pressure. Some institutions use human serum albumin, but it is costly and can be difficult to find. Some advocate using fresh frozen plasma (FFP) or a similar blood product, but there are dangers including citrate toxicity (from the anticoagulant), ABO incompatibility, infection, and cellular antigen See also Leukoreduction Plasmapheresis Venipuncture Pediatric Apheresis References External links NIH American Society for Apheresis WebPath Apheresis page. WebPath Blood Donation and Processing Donating Platelet Apheresis: Facts and the FAQ Hematology Medical treatments Nephrology procedures Transfusion medicine