Problems During the Usage and Dosage of Anticoagulants

Apheresis procedure is the extracorporeal separation of the blood into its components, selecting the desired part and returning the remaining part to the patient. Therapeutic apheresis procedures are applied in many diseases, especially in hematological disorders and neurological diseases, either as the main treatment method or as a complement to the main treatment model. Appropriate anticoagulant should be determined for the procedure, and calculations should be made correctly. Close follow-up is required during the procedure to determine any probable complications. Anticoagulants include citrate, heparin, or a combination of both. Citrate is the preferred anticoagulant for apheresis procedures. Mild hypocalcemia is the most common side effect, due to citrate anticoagulation. Heparin-based anticoagulation is limited to certain apheresis procedures. The heparin dose is titrated to achieve activated clotting times of 180–220 s. Prevention or treatment of low ionized calcium levels may consist of a low citrate dose or calcium replacement (oral or IV). Bleeding complications are related to heparin-based anticoagulation. With the help of competitive monitoring and precautionary measures, apheresis risks can be reduced.