The departments of Cardiology and Transfusion Medicine at Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST) has successfully performed its first LDL (bad cholesterol) apheresis procedure on a 34-year-old woman suffering from Homozygous Familial Hypercholesterolemia (HoFH), a rare genetic condition, which results in extremely high cholesterol levels from a young age.The procedure was led by a team consisting Harikrishnan S., Professor (Senior Grade), and Manish Yadav, from the Department of Cardiology and Amita R., Additional Professor from the Department of Transfusion Medicine.HoFH is characterised by severely elevated LDL cholesterol above 400mg/dl from birth, leading to premature atherosclerotic cardiovascular disease, beginning from childhood. Literature says that myocardial infarction (heart attack) can occur by the second decade of life. Untreated, median life expectancy for HoFH is just 33 years.“We do see cases of HoFH in our practice, with premature coronary artery disease or blocks in the blood vessels of the heart. This patient too had undergone coronary artery bypass surgery (CABG) at the very young age of 24 years. Even with the maximum tolerable dose of multiple cholesterol-lowering medications, her Low Density Lipoprotein (LDL) cholesterol levels remained dangerously high at 500 mg,” Dr. Harikrishnan said.The procedure involves drawing blood from the patient and passing it through an apheresis machine, which separates plasma from the blood cells. The plasma is then directed through a special adsorption column that traps LDL cholesterol.The treated plasma is recombined with the blood cells and safely returned to the patient. The entire process takes about two to three hours and the LDL value dramatically drops. In this case, it came down from 500mg/dl to 40 mg/dl.Plasma apheresis thus effectively removes over 60% of the LDL cholesterol but the procedure has to be repeated every two to four weeks—life-long—as the liver produces cholesterol again and the LDL level rebounds.“There are other options such as the twice-a-year siRNA injections but these are very expensive and not quite as effective as the apheresis process. The latter is the only available option, without which, the prognosis of the patient is grim. Each of the sessions cost ₹70,000 as the special cholesterol absorbing column used in the apheresis machine is expensive and its re-use is not recommended,” Dr. Harikrishnan said.The patient belongs to the BPL category and she could opt for this procedure as it was covered under the Karunya Arogya Suraksha Padhathi (KASP). However, given that the procedure has to be repeated every two-four weeks, KASP coverage would be hardly adequate to sustain her.This breakthrough marks a major step forward in the management of inherited cholesterol disorders in Kerala and south India. SCTIMST now joins a select group of centres in India offering this advanced therapy. Published - June 02, 2026 10:25 pm IST