range of DEHP exposure of the general population." The Baxter company manufactured blood bags without DEHP, but there was little demand for the product in the marketplace "Mean DEHP doses for both plateletpheresis techniques (18.1 and 32.3 μg/kg/day) were close to or exceeded the reference dose (RfD) of the US EPA and tolerable daily intake (TDI) value of the EU on the day of the apheresis. Therefore, margins of safety might be insufficient to protect especially young men and women in their reproductive age from effects on reproductivity. At present, discontinuous-flow devices should be preferred to avert conceivable health risks from plateletpheresis donors. Strategies to avoid DEHP exposure of donors during apheresis need to be developed." Therapy The various apheresis techniques may be used whenever the removed constituent is causing severe symptoms of disease. Generally, apheresis has to be performed fairly often, and is an invasive process. It is therefore only employed if other means to control a particular disease have failed, or the symptoms are of such a nature that waiting for medication to become effective would cause suffering or risk of complications. Plasma exchange – removal of the liquid portion of blood to remove harmful substances. The plasma is replaced with a replacement solution. LDL apheresis – removal of low density lipoprotein in patients with familial hypercholesterolemia. Lipoprotein(a) (Lp(a) apheresis Photopheresis – used to treat graft-versus-host disease, cutaneous T-cell lymphoma, and rejection in heart transplantation. Immunoadsorbtion with Staphylococcal protein A-agarose column – removal of allo- and autoantibodies (in autoimmune diseases, transplant rejection, hemophilia) by directing plasma through protein A-agarose columns. Protein A is a cell wall component produced by several strains of Staphylococcus aureus which binds to the Fc region of IgG. Leukocytapheresis – removal of malignant white blood cells in people with leukemia and very high white blood cell counts causing symptoms. Erythrocytapheresis – removal of erythrocytes (red blood cells) in people with iron overload as a result of Hereditary haemochromatosis or transfusional iron overload Thrombocytapheresis – removal of platelets in people with symptoms from extreme elevations in platelet count such as those with essential thrombocythemia or polycythemia vera. Indications ASFA categories In 2010, the American Society for Apheresis published the 5th Special Edition(1) of evidence based guidelines for the practice of Apheresis Medicine. These guidelines are based upon a systematic review of available scientific literature. Clinical utility for a given disease is denoted by assignment of