In apheresis, unwanted factors are taken out of the blood.

Apheresis only came to the attention of the ME/CFS community a couple of years ago. It’s big in some countries like Germany, but from what I can tell, is hardly used in the U.S. to treat ME/CFS or long COVID. If the authors of a couple of recent papers have their way, though, that will change.

Apheresis is a general term that refers to a process that removes unwanted elements in the blood. During the process, which usually takes from 2-4 hours, blood is drawn out, the unwanted part is removed from it, and the blood is returned to the patient. The type of apheresis anyone might undergo depends on which factors are removed from the blood. It’s an intriguing procedure given reports that an “X’ factor in the blood could be causing chronic fatigue syndrome (ME/CFS), fibromyalgia and long COVID.

Something in the Blood II: Long-COVID / Fibromyalgia Autoimmune Connection Found

The term can be quite confusing. At least a dozen different kinds of apheresis exist, including two that have been associated with ME/CFS – immunoadsorption and plasmapheresis.

  • Immunoadsorption – specific antibodies – also called immunoglobulins – are removed. B-cells produce these antibodies to ward off pathogens, but they’re also used to turn on or off various body processes.
  • Plasmapheresis – the plasma in the blood is totally removed and replaced.

(Berlin Cures has produced a drug called BC007 that it believes is more effective than immunoadsorption in mopping up specific autoantibodies. A long COVID trial is purportedly in the works.)

Berlin Cures…? Could BC 007 Help With Long COVID and ME/CFS?

Apheresis is an expensive process that can cost up to several thousand dollars per treatment and is used to treat myasthenia gravis, leukemia, sickle cell disease, multiple sclerosis, chronic fatigue syndrome, long COVID, and others.

While European doctors and researchers have been pushing apheresis for ME/CFS in medical journals, apheresis is actually a well-known procedure that’s commonly used in the U.S., as well – just typically not for chronic fatigue syndrome (ME/CFS).

The website for the American Society for Apheresis contains a section on long COVID that lists many apheresis facilities in the U.S. including UC San Diego, Cleveland Clinic, Kaiser, Stanford, the Mayo Clinic, Yale, etc. The Red Cross also maintains apheresis facilities across the U.S.

German Focus

The vast majority of apheresis work in ME/CFS and long COVID appears to have been done in several centers in Germany. Because the centers use different filters to filter out different elements and lack well-defined patient groups, it’s been impossible – other to note that it’s being used quite a lot – to assess its overall effectiveness. One center, though, has apparently been using a consistent approach that predates COVID-19 and it recently released some information.

Report From the Clinic

In their hypothesis paper, “Post COVID and Apheresis – Where are we Standing?”, the authors briefly reported on 1,111 ME/CFS patients who had undergone the INUSpheresis type of apheresis from 2009–2022.


Besides autoantibodies, INUSpheresis also reduces inflammatory cytokines, oxidated low-density lipoproteins, environmental toxins, and large molecules – all of which contribute – interestingly enough, to thickened blood, and therefore could affect blood flows.

Hamburg Biologicum, an apheresis center in Germany, reports:

“With INUSpheresis®/blood washing, we can simultaneously achieve several goals: We specifically flush out environmental toxins in the blood that cause disease and inflammation. In addition, we reduce the remaining inflammation mediators by half with every INUSpheresis®, i.e., we reduce the inflammation per session by approximately 50%. We also filter out malformed autoimmune antibodies. In other words, we are not tackling the rapidly increasing global phenomenon of autoimmune diseases with side-effect-rich “anti” agents, but instead explicitly removing their triggering factors like environmental toxins, inflammation mediators and malformed autoimmune antibodies.”

Their long Covid and vaccination injury approach includes doing lipid apheresis first, then a naturopathic infusion to combat inflammation, then INUSpheresis® apheresis as well as acetyl glutathione (an antioxidant), and a vitamin preparation. Infusion therapies that target clotting may be included as well.

Other types of apheresis could be effective in ME/CFS or long COVID. Pretorius and Kell, for instance, proposed that H.E.L.P.: apheresis (heparin-mediated LDL precipitation) – which removes factors that impair blood vessel health and improves blood flows may be helpful, improve blood flows in the microcirculation, and break down microclots.

Ischemia-Reperfusion Hypothesis Opens New Treatment Options for Long COVID, Fibromyalgia and ME/CFS


In Post COVID and Apheresis – Where are we Standing?”, the authors reported that 1111 patients diagnosed with ME/CFS following a variety of triggers (148 after COVID-19, 963 from other infections (e.g., Lyme disease, toxoplasmosis, EBV, or chlamydia), environmental factors (e.g., organic solvents) or unknown cause) had undergone INUSapheresis, and received steroids and high-dose vitamin C.

The authors reported that more was better with apheresis: 56% of the patients reported to be either cured or substantially improved following the 2nd INUSpheresis treatments, 64% were without symptoms or significantly better following the 3rd INUSpheresis treatment, and 74% were without symptoms or significantly better 6 months after the INUSpheresis treatments. Eleven percent reportedly experienced a moderate improvement and only 15% did not improve.

That was clearly good, if vague, news. We don’t know what “significantly improved” means, and no validated symptom testing was done, but the news overall was encouraging.

Long-COVID Study

Antibody chronic fatigue long COVID

In this study, the GPCR antibodies didn’t appear to make much of an impact.

The report on the 1,111 ME/CFS patients prompted a more rigorous study. As earlier, the study focused on long-COVID patients with classical symptoms of chronic fatigue (severe exhaustion, tiredness, post-exertional malaise, depression, headache, tinnitus, muscle pain, abdominal pain, and brain fog).

Twenty-seven patients in two different apheresis centers in Germany were again treated with the INUSpheresis type of apheresis. A steroid, prednisolone, was given between treatments to prevent the production of further autoantibodies and high-dose vitamin C was given to improve antioxidant capacity and reduce inflammation.


  • In apheresis the blood is removed from the body and then “washed” of unwanted substances and then returned to the body.  Depending on the type of apheresis done any number of substances – antibodies, pro-inflammatory factors, toxins – can be removed. The idea is intriguing, if as some studies suggest, an “X” factor exists in the blood that causes ME/CFS or FM that could be removed.
  • Apheresis to treat ME/CFS or long COVID doesn’t appear to be happening much in the U.S. but it’s regularly used in Germany and other European countries. Several hypothesis papers and one study by German and UK doctors were recently published.
  • One of the doctors reports concerned over 1000 ME/CFS patients seen over a 10-year period who had undergone a type of apheresis called INUSphersis which removes antibodies and inflammatory and oxidative stress factors. They also received a steroid and high-dose vitamin C. The report stated over half significantly improved or had no symptoms after the first treatment and with 2 or 3 treatments 64% reported significant improvement/no symptoms.
  • That prompted a 27-person study that also assessed GPCR antibody levels, and indicators of inflammation, oxidative stress, and coagulation. Apheresis significantly improved all these factors by at least 40% and in some cases up to 90%.
  • The fact that the GPCR antibody levels did not correlate with symptoms; that is some people with high antibody levels had mild symptoms while some people with low antibody levels had severe symptoms suggest they did not play a role.
  • The study was crude – it contained no healthy controls and referred to reference values for some of its findings – but it had a positive result and will hopefully lead to the randomized, placebo-controlled studies that we need to fully assess its effectiveness.
  • While apheresis does not appear to be used for ME/CFS much, apheresis is commonly done in the U.S. – usually a supplemental treatment to enhance the effectiveness of immunotherapies – and thus would be readily available if proven to be effective in ME/CFS and long COVID. (Another form of apheresis titled H.E.L.P. that removes clotting factors has been proposed).
  • Apheresis is used in a variety of diseases including myasthenia gravis, lupus, and sickle cell anemia. It’s expensive and can cost several thousand dollars per treatment.

Various factors (sCRP, IL-1beta, and IL-6), autoantibodies (against ß adrenergic receptors and acetylcholine receptors), lipids (chol, TG, LDL, HDL, and Lp(a)), thrombotic factors (fibrinogen and homocysteine), and H2O2 were measured.

Antibodies against α1- and β1-adrenergic receptors and the muscarinic acetylcholine receptors 3 and 4 were assessed using the CellTrend assay – whose efficacy has been questioned. Red blood cells were evaluated using a NIKON ECLIPSE E 200 microscope.

No healthy controls were included and the study was done on patients who had experienced “clinical improvements”.


Apheresis Helps – GCPR Antibodies Disappoint

Prior to apheresis, the antibodies were assessed relative to “reference levels” – not a strong measure – particularly given CellTrend’s possible problems. Three of the four antibodies were elevated according to that measure.

The apheresis did its job – it significantly reduced the levels of the autoantibodies by about 30-50% (ß1 &ß2-AdR, M3 &M4-AChR: 33%/ 28%, 48%, 39%). Markers of inflammation declined (sCRP, IL-1 beta and IL-6; 33%, 48%, and 64%) and so did, by one measure, oxidative stress (H202) (90%). Markers of coagulation (fibrinogen and homocysteine) dropped dramatically (70% and 64%) and cholesterol, triglycerides (TG), LDL, and HDL, fell below reference levels. Plus, other factors associated with coagulation (fibrin fibers, rouleaux structures (stacked red blood cells) disappeared.

The levels of the GCPR antibodies were not, however, associated with symptoms. In the discussion section, the authors made it clear that in this study, the antibodies did not tell the tale. Some patients with highly elevated antibodies were only mildly ill while others with normal antibody levels were quite ill.

As to symptoms – all we know is that the patients improved. That was expected – all the patients came from the improved group. Note that these doctors report that that is the largest group (70%).

The authors believe that several different pathways to long COVID exist and thought it unlikely for a single biomarker will, in the end, suffice. Instead, they believe that biomarker scores similar to those developed in autoimmune diseases will be developed to assess treatments in long COVID and ME/CFS.


The authors report filtering out unwanted elements in the blood can help.

The authors report filtering out unwanted elements in the blood can help. (Image from Alexdruz and Mæx and Wikimedia Commons)

Apheresis has clearly been used to treat ME/CFS in Germany for quite some time. I became aware of it as a treatment that could help wash out the GCPR antibodies that have created so much interest, but it’s clear that apheresis – a quite flexible treatment option – can do more than clear out these antibodies. In this case, that was a good thing, as the GPCR antibodies didn’t appear to figure in the patients’ symptoms. (This could be due to problems with the commercial method of assessing autoantibody prevalence. Researchers use a different method).

As one would expect from a blood cleansing procedure that does not get at the source of the problem, apheresis is usually not a standalone treatment and is usually used in combination with immunotherapies – as it was in this case.

The report concerning the 1,111 ME/CFS patients clearly came from doctors’ records. The smaller, more rigorous study was better but did not involve healthy controls, and relied on reference values and an antibody test that may be suspect.

The study did, however, show that apheresis can be pretty darn effective at washing out unwanted elements in the blood and may be helpful with symptoms. That was encouraging given findings in both ME/CFS and fibromyalgia that something in the blood is causing problems. It was also good to see that only a couple of sessions of this expensive procedure were needed.

An X-Factor in the Blood May Be Impairing Blood Vessel Functioning in ME/CFS

We clearly need much better studies to know what apheresis can and can’t do in ME/CFS and long COVID. While studies from clinics can’t match the rigor of clinical trials, they can get the word out and that’s what they did here. Whether it’s a case report or a small trial – even one that’s not particularly rigorous, like this one – publishing in a scientific journal is the best way to get a possible treatment in the hands of as many doctors as possible.

Apheresis doesn’t appear to be regularly used in the U.S. for ME/CFS but since it is a commonly used procedure and medical facilities are readily available the potential is there. If doctors in the U.S. or elsewhere want to give it a try, now they have a citation that might help and a roadmap they can follow. For their part, researchers have another possible treatment to try. Let’s hope these reports spark some interest and more investigations into this intriguing approach occur.


Patrick Ussher describes his apheresis experience at a German clinic.

“Your Blood is Black”: My ME/CFS Experience with HELP Apheresis in Germany

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