Regional
Advancing Excellence in Therapeutic Apheresis: The King Abdulaziz Medical City Experience
Hamdan Almutairi
MNGHA, Riyadh, Saudi Arabia
Khalid Batarfi
King Abdulaziz Medical City, Riyadh, Saudi Arabia
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Therapeutic apheresis has evolved from a specialised procedure into an essential component of modern multidisciplinary healthcare. At King Abdulaziz Medical City (KAMC), under the Ministry of National Guard Health Affairs (MNGHA), excellence in therapeutic apheresis has become both a guiding vision and a sustained institutional commitment.
Over the past decade, the service has undergone significant transformation. It has expanded in procedural volume, diversified its clinical modalities, and integrated international best practices in transfusion medicine and cellular therapy. Today, the programme stands as a regional model of excellence, combining advanced clinical care with research, innovation, and adherence to international quality standards.
Figure 1: Yearly growth in selected procedures (Plateletpheresis, Phlebotomy, Plasma Exchange, RCE, LDL, Apheresis, ECP, HPC collection) from 2013 to 2025.
Scope and Dimensions of Service Excellence
The strength of the Therapeutic Apheresis Service at KAMC lies in its broad clinical scope and its commitment to continuous improvement. Over the past decade, the programme has systematically expanded its therapeutic capabilities, providing procedures that address supportive transfusion needs, immune modulation, metabolic disorders, and cellular therapies.
Routine procedures include plateletpheresis, leukoreduction, therapeutic plasma exchange (TPE), red cell exchange (RCE), therapeutic phlebotomy, low-density lipoprotein (LDL) apheresis, and extracorporeal photopheresis (ECP). In addition, the service performs haematopoietic progenitor cell (HPC) collections for both autologous and allogeneic transplantation.
Beyond routine care, the programme supports research-oriented cellular collections, including lymphocyte collections for immunotherapy and gene-based therapies. These activities contribute to translational treatment approaches such as chimeric antigen receptor T-cell (CAR-T) therapy and emerging gene therapies for haemoglobinopathies.
This diversity of procedures reflects the service’s responsiveness to patient needs while positioning it as an integrated platform linking routine clinical care with innovative therapeutic approaches.
Quantitative Growth and Clinical Outcomes (2013–2025)
Between 2013 and August 2025, the Therapeutic Apheresis Service at KAMC performed 138,524 procedures, demonstrating sustained growth and increasing clinical integration. Overall activity increased by approximately 176% between 2013 and 2023, with further acceleration in 2024 and 2025.
The steady rise in procedures reflects both increasing clinical demand and the expansion of therapeutic capabilities. While platelet collections remain the dominant component of activity, the programme has also witnessed consistent growth in plasma exchange, red cell exchange, and cellular therapy collections.
Sustained Growth in Core Services
Plateletpheresis forms the backbone of the service. Since 2013, more than 39,000 platelet collections have been performed. This growth closely parallels the expansion of oncology and haematopoietic stem cell transplantation (HSCT) programmes, where reliable platelet support is critical for patient safety and treatment success.
Therapeutic phlebotomy represents another important component of the service, with nearly 7,500 procedures conducted during the study period. These interventions primarily address conditions such as polycythaemia vera and iron overload, reflecting the clinical needs of the patient population served by the institution.
Expansion of Therapeutic Modalities
Therapeutic plasma exchange has become a well-established treatment within the programme, accounting for more than 3,000 procedures. TPE is widely used in the management of autoimmune, neurological, and haematological disorders and represents a key therapeutic modality within modern apheresis practice.
Red cell exchange has demonstrated one of the most notable growth trajectories. From only a few procedures in 2013, annual activity has increased to more than 150 procedures per year, with a cumulative total of 754. This expansion reflects the increasing role of apheresis in the management of sickle cell disease and other haemoglobinopathies, conditions that are prevalent within the region.
Integration of Advanced Procedures
Over the past decade, KAMC has also successfully introduced advanced therapeutic modalities. LDL apheresis and extracorporeal photopheresis were implemented during the mid-decade and have since become important components of the service, with 839 LDL apheresis procedures and 805 ECP procedures performed.
Figure 2: Stacked bar chart showing how each procedure contributes to total workload annually (2013-2025).
Red Saturday
These treatments provide specialised options for patients with complex metabolic and immune-mediated disorders, illustrating the programme’s transition towards precision medicine and highly individualised therapies.
Cellular Therapy and Research Integration
Cellular therapy represents a growing area of activity. Since 2013, more than 1,700 HPC collections have been performed, including both autologous and allogeneic procedures. These collections form a cornerstone of the institution’s HSCT programme and are conducted in accordance with FACT–JACIE standards to ensure internationally recognised quality and safety benchmarks.
The programme also supports collections for advanced immunotherapies, including lymphocyte harvesting for CAR-T therapy and other research-based cellular interventions. More recently, gene therapy initiatives targeting sickle cell disease and thalassaemia have been incorporated into the programme. These developments place KAMC among a limited number of centres globally that actively integrate gene-based therapies within clinical practice.
Figure 3: Cumulative distribution of procedures (2013-Aug 2025) showing the proportion contributed by each modality.
Recent Trends (2024–2025)
In 2024, the service performed 17,294 procedures, representing the highest annual workload to date. By August 2025, 13,149 procedures had already been completed, suggesting that total activity for the year will surpass previous records.
Importantly, the increasing diversity of procedures demonstrates that the Therapeutic Apheresis Service has evolved into a comprehensive, multi-modal platform. It now supports both high-volume transfusion services and specialised therapeutic interventions.
Alignment with International Standards
The development of the Therapeutic Apheresis Service at KAMC closely reflects global trends reported by leading international organisations. Clinical practice follows the evidence-based recommendations of the American Society for Apheresis (ASFA), ensuring that procedures are guided by the most current therapeutic guidelines (Connelly-Smith et al., 2023).
Growth patterns within the programme are also consistent with data from the World Apheresis Association (WAA) Registry, where therapeutic plasma exchange, HPC collections, and LDL apheresis remain among the most commonly performed procedures worldwide (Stegmayr et al., 2025).
KAMC is an active participant in the international transfusion medicine community through its engagement with the International Society of Blood Transfusion (ISBT). This collaboration supports knowledge exchange and ensures that the programme remains aligned with evolving global standards.
Quality assurance is further strengthened through multiple institutional accreditations. The service adheres to the rigorous standards of the Foundation for the Accreditation of Cellular Therapy – Joint Accreditation Committee of ISCT and EBMT (FACT–JACIE), ensuring high-quality cellular therapy practices. Additional accreditations from the College of American Pathologists (CAP), the Association for the Advancement of Blood and Biotherapies (AABB), and the Saudi Central Board for Accreditation of Healthcare Institutions (CBAHI) reinforce the programme’s commitment to patient safety, quality improvement, and international recognition.
Research, Innovation, and Future Directions
Excellence at KAMC extends beyond current clinical practice to include a strong commitment to research and innovation. The apheresis service actively supports research collections for emerging cellular therapies, including CAR-T and gene-modified products.
These initiatives strengthen the institution’s translational research capabilities and ensure that patients have access to the latest therapeutic developments. As cellular and gene-based therapies continue to advance, the role of apheresis services in enabling these treatments is expected to grow significantly.
Teamwork and Institutional Vision
The success of the Therapeutic Apheresis Service at KAMC reflects the collective efforts of a highly skilled multidisciplinary team. Apheresis specialists, nurses, technologists, and physicians work collaboratively to ensure that every procedure—whether routine or highly specialised—is performed safely and effectively.
Close collaboration with referring clinicians across multiple specialties, including haematology, oncology, neurology, nephrology, and cardiology, has been central to the programme’s integration within clinical care pathways. The partnership with the Haematopoietic Stem Cell Transplant and Cellular Therapy Division has been particularly important, enabling seamless coordination of HPC collections for transplantation.
Institutional leadership within the Ministry of National Guard Health Affairs has also played a crucial role. Strategic investment and long-term vision have enabled the service to expand its capabilities and establish itself as a regional leader in advanced transfusion medicine and cellular therapy.
Ultimately, the continued growth and success of the programme are driven by the trust and resilience of patients and their families. Their experiences provide the motivation to pursue innovation, improve clinical outcomes, and maintain the highest standards of care in therapeutic apheresis.
