In Loa loa filariasis the number of microfilaria can be very high. The higher the number the greater the risk of complications. Apheresis can be used to quickly reduce the number to levels that are associated with fewer adverse effects.
Intermittent apheresis works by concentrating microfilaria in the buffy coat which is not reinfused into the patient..
There does not appear to be a specific threshold for apheresis therapy. It may be considered for any patient with a microfilaria level > 10,000 microfilaria per mL blood. The higher the load the greater the need.
Apheresis results in only a transient reduction in microfilaria. The goal is to quickly reduce the microfilaria as much as possible, after which chemotherapy can be started to complete the cure.
Thrombocytopenia secondary to the apheresis may limit the number of treatments that a patient can receive.
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