Bringing Therapeutic Apheresis to Northern Virginia

The Kaplan Center for Integrative Medicine is one of the country’s leading integrative medicine practices, caring for patients across the Washington, D.C. metro area from its home in McLean, Virginia. Led by Dr. Gary Kaplan, who is board-certified in both Family Medicine and Pain Medicine, the Center has long taken on the conditions that frustrate conventional care: chronic pain, autoimmune disease, post-infectious syndromes, cognitive decline. So when the clinical evidence for therapeutic plasma exchange began to consolidate around the same conditions the Center was already treating, adding TPE to the practice became an obvious goal.

Making it happen was the hard part. Standing up an outpatient therapeutic plasma exchange program independently is, for almost any physician-owner, significantly harder than it looks from the outside. Apheresis sits outside the standard competencies of family medicine, pain medicine, and integrative practice; the physicians who perform it well have usually spent years training in transfusion medicine, clinical immunology, or hematology before they ever sit at a separator. The clinical expertise required to direct a program is narrow, deep, and not something that can be bought off a shelf.

The staffing problem is harder still. Apheresis-trained nurses are a tiny subspecialty within an already scarce profession, and the nurses who do exist are concentrated in academic medical centers and hospital-based programs. Recruiting one to an outpatient integrative practice, in a region without a nearby outpatient program to train from, is a multi-year search in its own right.

Then there is the equipment and supply chain. FDA-cleared cell separators, the disposable kits specific to each separator, albumin and replacement fluids, and the ancillary consumables required for every procedure all sit inside a medical supply infrastructure built for hospital buyers rather than for solo practices. And above all of that sits the clinical protocol layer: therapeutic apheresis is ASFA-categorized by indication, with evidence-grade recommendations that differ by condition, and outpatient applications for conditions like Alzheimer’s, Long COVID, and PANS/PANDAS are still an emerging discipline where protocol depth lives inside a small number of practices.

Four years was not a motivation problem. It was an infrastructure problem — the expertise, staffing, supply chain, and protocol depth required to do this safely, well, and at the standard of care the Kaplan Center’s patients have come to expect.

Affiliate onboarding at Global Apheresis takes the form of a multi-day, hands-on immersion at the originating practice rather than a Zoom call and a protocol handoff. Dr. Kaplan traveled to Mill Valley and spent several days on-site at the flagship clinic, working directly with Dr. Kiprov and the clinical team: reviewing patients, observing procedures, discussing protocol design, and talking through the edge cases that only show up in a working practice.

The depth of transfer matters. Therapeutic apheresis is a procedural discipline, and a physician joining the network is being brought into a clinical tradition with decades of accumulated judgment behind it, not simply handed a recipe to follow. The only way to transfer that judgment is to stand next to the person who carries it, on the floor, while patients are being treated.

The apheresis-trained nurse who will be embedded at Kaplan Center is trained through the same program. The nurse and the physician arrive in McLean already speaking the same clinical language, already aligned on protocol, and already integrated into the broader Global Apheresis team, because they were trained together at the same site by the same people.

The most telling thing about the Kaplan-Kiprov partnership may be the way the two physicians talk to each other. In the recorded conversation from Kaplan’s training week, they spend significant time on the PANS/PANDAS protocol, specifically on IVIG dosing after plasma exchange. Kiprov describes a Johns Hopkins transplant-rejection model: giving 100 to 200 milligrams per kilogram of IVIG after a plasma exchange procedure, rather than the traditional 1.5 grams per kilogram used in standalone IVIG therapy. Kaplan presses on it: what the evidence supports, how the outcomes compare, what this means for PANS/PANDAS kids whose families are often paying out of pocket for either therapy.

The exchange reads as two working physicians comparing clinical data, not as a franchisor lecturing a franchisee. It is the part of the partnership that prospective affiliates tend to underestimate from the outside: the ongoing conversation about how the protocols evolve, which cases teach the network something new, and where the literature is ahead of common practice. In the same conversation, Kaplan references “a couple of research possibilities” he and Dr. Kiprov have been discussing, which is what happens when the relationship is structured as clinical community rather than as licensing.

Kaplan’s own framing of what this means for his patient population lands the point:

“I’m very excited to be bringing this therapy to the office in McLean, and looking forward to being able to have a tool that I believe is going to be able to help hundreds, if not thousands, of more of our patients as we move forward.”

Dr. Gary Kaplan, D.O.

For a physician-owner evaluating this program, that is the question underneath every other question. By design, affiliate physicians join a small clinical community that takes their judgment seriously, includes them in the work of refining protocols, and treats them as colleagues rather than customers.