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What Is Apheresis and Why Is It Used for Long COVID?
Apheresis is a medical procedure in which blood is drawn from the patient, passed through a specialized filter that selectively removes harmful substances, and returned to the body. In the context of long COVID, apheresis has emerged as one of the most promising therapeutic approaches for patients whose symptoms are driven by persistent microclots, elevated inflammatory proteins, and impaired microcirculation.
At St. George Hospital (Klinik St. Georg) in Bad Aibling, Germany, we use H.E.L.P. apheresis (Heparin-induced Extracorporeal LDL Precipitation) as a core component of our post-COVID treatment program. This technology was originally developed for patients with severe lipid disorders but has proven remarkably effective for removing the pathological blood components that drive long COVID symptoms.
Dr. Julian Douwes, Chief Medical Officer, states: “Apheresis allows us to directly remove the substances that are perpetuating illness. Rather than waiting for the body to clear microclots and inflammatory proteins on its own—a process that may take months or never fully occur—we can mechanically filter them out and give the body a clean foundation for recovery.”
The Science: Microclots, Spike Protein, and Autoantibodies
Microclots and Impaired Microcirculation
Research by Dr. Beate Jaeger, Dr. Etheresia Pretorius, and others has identified persistent fibrin-amyloid microclots in the blood of long COVID patients. These are not ordinary blood clots—they are resistant to the body’s normal fibrinolytic (clot-dissolving) processes and accumulate in the microcirculation, the network of tiny capillaries that deliver oxygen and nutrients to every organ.
When microclots obstruct microcirculation, the consequences can be widespread:
- Brain: Brain fog, cognitive impairment, headaches
- Lungs: Shortness of breath, exercise intolerance
- Muscles: Fatigue, post-exertional malaise, pain
- Heart: Palpitations, chest tightness
- Peripheral nerves: Numbness, tingling, small fiber neuropathy
This represents an important research direction, and while the microclot hypothesis continues to be studied, the clinical observations at facilities treating long COVID patients are compelling.
Persistent Spike Protein
Emerging research suggests that fragments of the SARS-CoV-2 spike protein may persist in tissues and blood for months after infection. These fragments can:
- Trigger ongoing immune activation
- Contribute to endothelial dysfunction
- Promote the formation of new microclots
- Activate the complement system, perpetuating inflammation
Autoantibodies
A significant subset of long COVID patients develop autoantibodies—immune proteins that mistakenly attack the body’s own tissues. Common targets include:
- G-protein coupled receptors (affecting autonomic nervous system function)
- Endothelial cell surface proteins
- Neuronal antigens
These autoantibodies can drive symptoms such as dysautonomia, fatigue, and neurological dysfunction. Apheresis can physically remove circulating autoantibodies, providing relief while the underlying immune dysregulation is addressed through complementary therapies (Wallukat et al., Molecular Medicine, 2021).
How H.E.L.P. Apheresis Works
The Procedure Step by Step
- Venous access: Two intravenous lines are placed, typically one in each arm. One line draws blood, the other returns filtered blood.
- Heparin precipitation: The drawn blood is mixed with heparin at a low pH, which causes precipitation (clumping) of LDL cholesterol, fibrinogen, and associated pathological proteins including microclots.
- Filtration: The precipitate is removed via a specialized filter. This step removes microclots, excess fibrinogen, inflammatory proteins, lipoproteins, and circulating autoantibodies.
- Bicarbonate dialysis: The filtered plasma is passed through a bicarbonate dialysis step to restore normal pH and remove the heparin.
- Return: The cleaned plasma is recombined with the patient’s blood cells and returned to the body.
What H.E.L.P. Apheresis Removes
- Microclots: Fibrin-amyloid deposits that resist normal fibrinolysis
- Fibrinogen: Reduced by approximately 50–60% per session
- LDL cholesterol: Reduced by approximately 60–70% per session
- Lipoprotein(a): A pro-thrombotic lipoprotein reduced by ~60%
- C-reactive protein (CRP): Inflammatory marker reduced by ~50%
- Autoantibodies: Circulating autoimmune proteins
- Spike protein fragments: Protein-bound viral remnants
Duration and Comfort
- Session duration: Approximately 2–3 hours
- Comfort: Patients sit in a comfortable reclining chair. The procedure is painless beyond the initial IV insertion. Many patients read, work on laptops, or rest during treatment.
- Side effects: Generally minimal. Some patients experience mild fatigue or lightheadedness immediately after treatment, which resolves quickly.
How Many Apheresis Sessions Are Needed?
The number of sessions depends on the severity of symptoms, baseline laboratory values, and clinical response:
- Mild to moderate long COVID: 3–5 sessions over 1–2 weeks
- Severe or prolonged long COVID: 5–10 sessions over 2–4 weeks
- Maintenance (for persistent cases): Monthly or quarterly sessions as needed
We monitor response through:
- Serial blood work (fibrinogen, D-dimer, CRP, lipid panel)
- Symptom scoring questionnaires
- Functional assessments (exercise tolerance, cognitive testing)
- Dark-field microscopy to visualize blood quality changes
Clinical Results: What Patients Experience
Based on our clinical experience at St. George Hospital treating long COVID patients with H.E.L.P. apheresis:
Short-Term (Within Days of First Sessions)
- Improved mental clarity (“brain fog lifting”)
- Increased energy levels
- Reduced headache intensity
- Improved exercise tolerance
Medium-Term (After Full Treatment Course)
- Significant reduction in fatigue severity
- Improved cognitive function
- Reduced shortness of breath
- Improved sleep quality
- Reduction in post-exertional malaise
Long-Term Sustainability
The durability of results depends on the degree to which underlying immune dysregulation has been addressed. Apheresis removes the immediate burden of pathological substances, but comprehensive treatment should also address:
- Ongoing inflammation (via ozone therapy, IV nutrients, anti-inflammatory protocols)
- Immune rebalancing (via immunomodulatory therapies)
- Mitochondrial support (via NAD+ infusions, CoQ10, IHHT)
- Gut health restoration (often compromised in long COVID)
Research Supporting Apheresis for Long COVID
While large-scale randomized controlled trials are still underway, the existing evidence base is growing:
- A German case series by Jaeger et al. demonstrated significant improvement in symptoms and biomarkers after H.E.L.P. apheresis in long COVID patients with evidence of impaired microcirculation (Jaeger et al., Molecular Medicine, 2022).
- Pretorius and colleagues have extensively characterized the fibrin-amyloid microclots found in long COVID patients and demonstrated their resistance to normal fibrinolysis (Pretorius et al., Cardiovascular Diabetology, 2021).
- Multiple clinical centers in Germany and Europe have reported positive outcomes with apheresis-based approaches, contributing to a growing consensus that blood filtration has a role in managing long COVID.
It is important to note that apheresis for long COVID is considered an innovative clinical application. While H.E.L.P. apheresis is an established, approved medical technology with decades of safety data, its specific application for long COVID continues to be evaluated through ongoing research. At St. George Hospital, we apply this technology within a rigorous medical framework with careful patient selection and monitoring.
Apheresis as Part of a Comprehensive Long COVID Program
At St. George Hospital, apheresis is never used in isolation. It is one component of our comprehensive post-COVID treatment program, which typically includes:
- Thorough diagnostic evaluation (blood work, imaging, functional testing)
- H.E.L.P. apheresis (for patients with evidence of microclots/impaired microcirculation)
- Ozone therapy (immune modulation, improved oxygenation)
- Intravenous nutrient therapy (vitamin C, glutathione, NAD+, minerals)
- IHHT (interval hypoxia-hyperoxia training for mitochondrial renewal)
- Rehabilitation (structured exercise, breathing therapy, autonomic regulation)
Frequently Asked Questions
Is apheresis painful?
No. The only discomfort is the initial placement of the two IV lines, comparable to a standard blood draw. During the 2–3 hour procedure, patients feel no pain. Many patients describe a sense of “lightness” or improved clarity during or immediately after the session.
How quickly will I notice improvement?
Many patients report noticeable improvement in brain fog, energy, and headache after the first 1–2 sessions. More substantial and sustained improvement typically develops over the full treatment course of 3–10 sessions. Some patients experience a temporary “detox-like” response (mild fatigue, headache) in the hours following a session, which resolves quickly.
Are there risks to apheresis?
H.E.L.P. apheresis is a well-established medical procedure with a strong safety record spanning decades. Potential side effects are generally mild and include: temporary blood pressure changes during the procedure, mild fatigue, and bruising at the IV sites. Serious complications are very rare when the procedure is performed by experienced medical teams with proper monitoring.
Is apheresis covered by insurance?
Coverage varies by insurer and country. German private insurance plans increasingly recognize apheresis for long COVID when supported by documented medical indication. We provide comprehensive treatment documentation to support insurance claims for international patients. We recommend contacting your insurance provider prior to treatment to discuss coverage.
Who is a good candidate for apheresis?
Ideal candidates for apheresis in the context of long COVID include patients with: persistent symptoms beyond 12 weeks after COVID-19 infection, elevated inflammatory or coagulation markers (fibrinogen, D-dimer, CRP), evidence of microclot formation (via dark-field microscopy or specialized testing), and symptoms consistent with impaired microcirculation (brain fog, fatigue, exercise intolerance, shortness of breath).
Take the First Step Toward Recovery
If you are suffering from long COVID and have not found relief through conventional treatments, apheresis may offer the targeted intervention your body needs. Contact our international patient team to discuss whether apheresis is appropriate for your situation.
Phone: +49 (0)8061 398-0
Email: info@clinicum-stgeorg.de
Location: Rosenheimer Str. 6-8, 83043 Bad Aibling, Germany
Disclaimer: Apheresis for long COVID is an innovative clinical application of established blood filtration technology. While early results are promising and the underlying science is compelling, large-scale randomized trials are ongoing. Individual outcomes vary. Treatment decisions should be made in consultation with qualified healthcare professionals.
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