American Society for Apheresis

View all recommendations from this society

April 25, 2018; updated February 15, 2022

Do not routinely monitor coagulation tests during a course of therapeutic plasma exchange, unless the procedure is performed daily.

For most indications, therapeutic plasma exchange can be performed on an intermittent schedule using clotting factor deficient replacement fluid without the need for routine monitoring of the patient’s hemostasis status. Daily treatments significantly reduce clotting factors; therefore, coagulation testing may be appropriate and clinical circumstances may indicate baseline and prospective laboratory coagulation parameters be measured.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physicians.

How The List Was Created

Recommendations were drafted by the ASFA Choosing Wisely Working Group, which consisted of nine society members from the major committees of ASFA. Guiding principles included a focus on frequent practices that should be questioned, are supported by evidence, free from harm, truly necessary and not duplicative of other procedures or tests. Nine draft statements were reviewed, rated and ranked, using a nominal group scoring approach, by 41 physician and allied health members representing a diverse cross-section of apheresis medicine practitioners and content experts. The top five draft recommendations, chosen by cumulative rating and ranking scores, were further refined before submission to the Board of Directors and the ABIM Foundation for external review. Recommendations were incorporated by the ASFA Choosing Wisely Working Group into the final list, which was ultimately approved by the Board of Directors for publication and distribution.

ASFA Choosing Wisely Working Group – (Committee representation)

Michael Linenberger, MD (Chair) – University of Washington/Fred Hutchinson Cancer Research Center
Joseph Schwartz, MD, MPH (Research Committee) – Columbia University Irving Medical Center
Sarita Joshi, MD (Communications Committee) – Cleveland Clinic Foundation
Meghan Delaney, DO, MPH (Clinical Applications Committee) – Children’s National Health System
Christine Fernandez, RN, MSN/Ed, OCN (Allied Health Committee) – Consultant
Laura Connelly-Smith, MBBCh, DM (JCA Special Issue Committee) – University of Washington/Fred Hutchinson Cancer Research Center
Vishesh Chhibber, MD (Education Committee) – Northwell Health
Yvette Tanhehco, MD, PhD, MS (Apheresis Physicians Committee) – Columbia University Irving Medical Center
Quentin Eichbaum, MD, PhD, MPH (International Affairs Committee) – Vanderbilt University


Weinstein R. Basic Principles of Therapeutic Blood Exchange. In: McLeod BC, Szczepiorkowski ZM, Weinstein R, Winters JL, eds. Apheresis: Principles and Practice, 3rd edition. Bethesda, MD: AABB Press, 2010:269-93.

Tek I, Arslan, O, Arat M, Ozcan M, Akdag B, Ilhan O. Effects of replacement fluids on coagulation system used for therapeutic plasma exchange. Transfus Apher Sci. 2003;28(1):3-7.

Zantek ND, Morgan S, Zantek PF, Mair DC, Bowman RJ, Aysola A. Effect of therapeutic plasma exchange on coagulation parameters in patients on warfarin. J Clin Apher. 2014;29(2):75-82.