What is selective apheresis and how does it work?
Selective apheresis is a blood-purification procedure in which blood is drawn from the body, passed through a specialised filter or adsorption column that captures only specific target substances, and then returned. Unlike general plasmapheresis — which removes the whole plasma and replaces it — selective apheresis uses columns designed to bind a chosen molecule: for example, low-density lipoprotein (LDL) cholesterol, immunoglobulins, immune complexes or inflammatory mediators. Because only the targeted substance is removed, the rest of the plasma proteins are returned with the blood, which reduces the need for replacement fluids. This selectivity is the key practical difference from broader apheresis methods. For an overview of how the wider family of blood-purification treatments works, see our guide to regenerative treatments in Turkey.
Clinics in Turkey use selective apheresis as part of treatment plans for certain autoimmune conditions, refractory high cholesterol (familial hypercholesterolaemia) and selected inflammatory diseases where the offending molecule has been clearly identified. This page explains the mechanism, what the evidence supports, what sessions cost and what a course of treatment involves.
Which substances does selective apheresis target?
The column or membrane used in a session is chosen according to the molecule to be removed. The most established clinical uses involve:
- LDL apheresis — columns bind apolipoprotein B-containing lipoproteins and are used in familial hypercholesterolaemia when medication alone is insufficient.
- Immunoadsorption — protein A, anti-human IgG or antigen-specific columns remove circulating antibodies (IgG, IgM) in autoimmune conditions such as refractory myasthenia gravis, autoimmune cardiomyopathy and selected kidney diseases.
- Cytokine or inflammatory-mediator removal — used in severe inflammatory states to reduce circulating cytokines.
- Lipoprotein(a) removal — some columns have selectivity for Lp(a), which is linked to cardiovascular risk and not well controlled by standard medication.
The column choice is made by a physician on the basis of your diagnosis, laboratory results and treatment history. A session using the wrong column will not achieve the intended effect, so the diagnostic work-up before starting a programme is essential.
Does selective apheresis work? What the evidence says
The evidence base varies considerably by indication. LDL apheresis for familial hypercholesterolaemia has the strongest support: guidelines from the European Atherosclerosis Society and national bodies recognise it as an established treatment for patients with severely elevated LDL who do not respond adequately to medication. Studies consistently show acute reductions of 60–70 % in LDL per session, and regular sessions reduce cardiovascular event rates in this high-risk group.
Immunoadsorption for autoimmune diseases has a solid record for myasthenia gravis crises and certain antibody-mediated nephropathies; evidence in other autoimmune conditions is positive but drawn from smaller trials. Cytokine-removal columns are an active area of research; they are used clinically in some centres but the evidence from large randomised trials is still accumulating.
No form of selective apheresis is a cure: it removes a substance temporarily and sessions usually need to be repeated at intervals, alongside ongoing medical treatment. A trustworthy clinic will describe what it can realistically achieve for your diagnosis and will not claim that sessions alone will resolve an underlying disease.
Selective apheresis cost in Turkey compared with the UK, US and Germany
Costs depend heavily on the type of column, the number of sessions prescribed and whether the programme is delivered as day-case or with an overnight stay. The figures below are approximate per-session ranges, not hospital quotes; a full programme of multiple sessions will cost more. Each hospital confirms its own price in a written quote.
| Country | Approximate cost per session |
|---|---|
| Turkey | €800 – €2,500 |
| United Kingdom | €2,000 – €5,500 |
| United States | €2,500 – €7,000 |
| Germany | €1,800 – €5,000 |
What changes the price: the type of column (immunoadsorption columns cost more than lipid-removal columns), the number of sessions in the programme, whether columns are single-use or regenerable, the complexity of the monitoring required and what the package includes. A package in Turkey typically covers pre-treatment laboratory tests, all sessions, medical supervision, accommodation if needed, medication during the programme and airport transfers. Ask for a written breakdown before agreeing to anything.
Selective apheresis compared with plasmapheresis and therapeutic apheresis
All three procedures draw blood and process it outside the body, but they differ in what they remove and what is returned. Understanding the difference helps you ask the right questions at a consultation.
| Method | What is removed | Typical use |
|---|---|---|
| Selective apheresis | One specific molecule or class (e.g. LDL, IgG antibodies) | Familial hypercholesterolaemia, antibody-mediated autoimmune disease, Lp(a) elevation |
| Plasmapheresis | Whole plasma (replaced with albumin or donor plasma) | Guillain-Barré syndrome, TTP, broad autoimmune crises |
| Therapeutic apheresis | Plasma, cells or specific components depending on modality | Range of haematological and autoimmune conditions |
The key advantage of the selective approach is that plasma proteins not implicated in the condition — clotting factors, albumin, immunoglobulins other than those targeted — are returned, which reduces replacement-fluid requirements and some side effects. The disadvantage is that it requires a precisely specified target and the right column; it is not suitable when multiple substances need to be removed or when the pathological molecule has not been identified. See also our page on DFPP plasmapheresis, a double-filtration method that sits between whole-plasma exchange and full selectivity.
Who is a good candidate for selective apheresis?
Selective apheresis suits adults (and in some programmes children) who have a clearly identified circulating molecule driving their condition and who have not achieved adequate control through medication alone. The clearest candidates are people with familial hypercholesterolaemia and very high LDL or Lp(a) despite maximal lipid-lowering therapy, and people with antibody-mediated autoimmune diseases where immunoadsorption is an established part of the management pathway.
You are less suited if your condition does not involve a removable circulating substance, if your illness is not yet diagnosed or stable enough for planned sessions, if you have severe anaemia (haemoglobin below the threshold set by the treating team), active serious infection, haemodynamic instability, or contraindications to anticoagulation used during the procedure. Pregnancy and certain medications that interact with the column material are also assessed individually. A physician review and full blood panel are needed before the programme begins.
What happens during a selective apheresis session: step by step
Sessions are planned and supervised by a physician with experience in apheresis medicine. A typical session runs as follows:
- Vascular access: blood is drawn through a peripheral vein (antecubital fossa) or, for long programmes, through a temporary central venous catheter. Access is confirmed before the session starts.
- Anticoagulation: heparin or citrate is given to prevent clotting in the circuit; the dose is adjusted for your weight and kidney function.
- Processing: blood passes through the apheresis machine to a centrifuge or membrane separator that isolates the plasma, then through the selective column. The column binds the target substance; the treated plasma and the cellular components are recombined and returned.
- Duration: a single session typically takes two to four hours, depending on the volume of plasma processed and the target substance. You sit or lie in a recliner and are monitored continuously.
- Post-session check: vital signs and, in some protocols, a blood sample are checked before you are discharged. Most people leave within 30 minutes of the session ending.
A typical course involves two to three sessions per week over one to three weeks for acute conditions, or regular maintenance sessions (for example fortnightly) for chronic conditions such as familial hypercholesterolaemia. The physician prescribes the interval and total number based on your laboratory response.
Recovery and what to expect between sessions
Most people tolerate individual sessions well and return to normal activities the same day. The most common sensations during a session are mild coldness from the returning blood and tingling around the lips or fingers if citrate anticoagulation is used (a sign of temporary low calcium, managed with a supplement given during the session). Some people feel tired for a few hours afterwards.
Between sessions there are no wound-care requirements. You continue any prescribed medications unless the physician says otherwise. Blood tests at intervals track the response — in LDL apheresis this means checking LDL levels immediately after a session and immediately before the next to understand the rebound rate. For longer programmes planned in Turkey, typical stays range from one to three weeks depending on the number of sessions; a programme coordinator will advise on the schedule and accommodation. Read about how the planning process works before you book.
Risks and complications
Selective apheresis is a medical procedure with a well-characterised safety profile when performed in a licensed facility by trained staff, but it is not without risk. Common, usually mild effects include:
- Hypotension (a drop in blood pressure) during or after the session, managed by slowing the blood flow or giving fluid.
- Citrate-related hypocalcaemia: tingling, cramps and nausea, corrected by calcium infusion.
- Access-site bruising or discomfort, particularly around a peripheral cannula.
- Fatigue and mild headache after the session.
Less common complications include allergic or anaphylactic reactions to column materials (documented mainly with certain protein A columns and ACE inhibitor use — the two must not be combined), clotting in the circuit, infection at a central catheter site and, rarely, haemodynamic instability. Professional societies including the American Society for Apheresis (ASFA) publish guidelines on indications, technique and complication management; ask the clinic which category your condition falls into in the ASFA grading system, as this tells you how strong the evidence is for your specific use.
How to choose a clinic and questions to ask
Selective apheresis requires specialist equipment, trained nursing staff and physician oversight; it cannot safely be offered in a general cosmetic or wellness setting. When evaluating a clinic, check that the apheresis unit is part of a licensed hospital with haematology or nephrology expertise, that the physician prescribing your programme is a specialist in the relevant field, and that the facility holds the appropriate regulatory authorisation for the column type used in Turkey.
Red flags include clinics that offer apheresis for unproven indications without a diagnostic work-up, that cannot name the column or explain its selectivity, that quote a fixed number of sessions before reviewing your laboratory results, or that cannot explain what happens if you have a reaction during a session. Request a written treatment plan and price before paying anything. You can start by submitting your records through our free quote page; the clinical team reviews your diagnosis and sends a written proposal.
Questions to ask the clinic before committing:
- Which column will be used for my condition, and why?
- What laboratory result would indicate the programme is working, and when will you check it?
- How many sessions do you anticipate, and what interval?
- What anticoagulation protocol do you use, and do I take any ACE inhibitors that could interact?
- What monitoring is in place during each session, and who is the supervising physician?
- What is your protocol if I have an allergic or haemodynamic reaction?
- What follow-up is provided after I return home?
Hospitals with Regenerative Medicine in Turkey
Frequently asked questions
Selective apheresis is a blood-purification procedure in which blood is drawn from the body, passed through a column or filter that binds one specific target substance — such as LDL cholesterol or harmful antibodies — and then returned. Unlike plasmapheresis, the rest of the plasma proteins are kept and returned with the blood.
It depends on the condition. LDL apheresis for familial hypercholesterolaemia has strong evidence from professional guidelines and consistently reduces LDL by 60–70 % per session. Immunoadsorption for antibody-mediated autoimmune diseases is well supported for certain diagnoses. For other uses the evidence is still developing; sessions are not a cure and are usually repeated alongside medication.
Approximate ranges are €800 to €2,500 per session in Turkey, compared with €2,000 to €5,500 in the UK. The final cost depends on the column type, number of sessions and what the package includes; each hospital confirms its price in a written quote.
Plasmapheresis removes all plasma and replaces it with albumin or donor plasma. Selective apheresis removes only one target substance through a specialised column and returns the rest of the plasma proteins. This reduces the need for replacement fluid and preserves useful proteins such as clotting factors.
The number depends on your condition. Acute autoimmune crises may need two to three sessions per week for one to two weeks. Chronic conditions such as familial hypercholesterolaemia often require regular maintenance sessions every one to two weeks long-term. The physician decides the schedule based on your laboratory response.
The procedure itself is not painful. You may feel mild coldness from the returning blood and, if citrate anticoagulation is used, tingling in the lips or fingers — this is managed with a calcium supplement given during the session. Some people feel tired for a few hours afterwards.
Common effects are mild drops in blood pressure, citrate-related tingling or cramps and fatigue. Less common risks include allergic reactions to the column material (particularly with protein A columns if you take ACE inhibitors), circuit clotting, catheter-site infection and haemodynamic instability. Serious reactions are uncommon in accredited apheresis units.
A short acute programme of four to six sessions usually requires one to two weeks. Maintenance programmes can be timed around regular visits or arranged locally at home. The clinic will propose a schedule based on your diagnosis and travel plans.
People with severe anaemia, active serious infection, haemodynamic instability or contraindications to anticoagulation are not suitable until those issues are addressed. ACE inhibitor use is a contraindication with certain protein A columns. A full medical review and blood panel are needed before starting.
Before: you attend for blood tests and a physician consultation to confirm the target substance, column choice and session schedule. During: you sit or lie for two to four hours per session with continuous monitoring. After: most people resume normal activity the same day. The benefit is tracked through laboratory results — for example LDL levels — rather than visible physical change.