Therapeutic apheresis: when things go wrong.

Therapeutic apheresis medicine requires in-depth knowledge of physiology, disease mechanisms as well as a thorough understanding of the parameters that can be adjusted in the instrument that are used. We report two cases where critical decision making was crucial during management of patients being treated with therapeutic apheresis. Case 1 involves an adult patient with severe circulating cryoglobulins and Case 2 describes a patient with Waldenström's macroglobulinemia and hyperviscosity. Both cases demonstrate the importance of readily available expert supervision of therapeutic apheresis procedures.