The quality of evidence supporting the use of apheresis in the treatment of individual diseases and disorders is often limited. For most diseases and disorders, randomized controlled trials of the use of apheresis have not been performed and for many, due to rarity of the condition, it is unlikely that they will ever be performed. In keeping with its vision, the American Society for Apheresis (ASFA) has created and regularly updated guidelines on the use of apheresis in the treatment of disease. These guidelines seek to summarize the literature on the use of apheresis in treating diseases, provide a critical review of this literature, and give practical guidance to apheresis practitioners. The most recent ASFA guidelines were published in 2010. This article reviews the history of the ASFA guidelines, the changes that were made in the 2010 guidelines, and future directions and plans for these guidelines. The 2010 ASFA guidelines on the use of therapeutic apheresis in clinical practice represent the state of the art in apheresis medicine in 2010. J. Clin. Apheresis 26: 239-242, 2011. (C) 2011 Wiley-Liss, Inc.