Therapeutic plasma exchange in children: One center's experience. Issue 6 (9th May 2017)

• Record Type: Journal Article
• Authors: Cortina, Gerard; Ojinaga, Violeta; Giner, Thomas; Riedl, Magdalena; Waldegger, Siegfried; Rosales, Alejandra; Trojer, Raphaela; Hofer, Johannes
• Is Part Of: Journal of clinical apheresis. Volume 32:Issue 6(2017)
• Page Start: 494
• Page End: 500
• Publication Date: 2017-05-09
• Subjects: apheresis -- pediatric intensive care unit -- pediatric population -- therapeutic plasma exchange; Hemapheresis -- Periodicals; Blood -- Transfusion -- Periodicals; Blood -- Transfusion, Autologous -- Periodicals; Cell separation -- Periodicals; Leukapheresis -- Periodicals; Plasmapheresis -- Periodicals; 615.39
• DOI: 10.1002/jca.21547
• Languages: English
• ISSNs: 0733-2459

Abstract

Abstract: Background: Therapeutic plasma exchange (TPE) has evolved to an accepted therapy for selected indications. However, it is technically challenging in children. Moreover, data on safety and efficacy are mainly derived from adult series. The aim of this study was to review the procedure in the context of clinical indications, effectiveness, and safety. Study Design and Methods: All TPE procedures performed at a tertiary care hospital during a 12‐year period (2005–2016) were retrospectively evaluated. Results: Eighteen patients with a median age of 8.5 (0.2–17) years underwent a total of 280 TPE sessions. Eleven (61%) patients were treated for renal diseases. Three (17%) patients were diagnosed with neurological diseases, two had liver failure, and one patient each had sepsis and stem cell transplant‐associated thrombotic microangiopathy. Seven patients (39%) were classified as American Society for Apheresis Category I, four (22%) as Category II, two (13%) each as Category III and IV, and two (13%) were not classified. Two patients with atypical hemolytic‐uremic syndrome received TPE as long‐term therapy over 2 and 5 years. All procedures were performed using the filtration technique and heparin anticoagulation. Twelve (67%) patients showed full or partial recovery after TPE, six had no response or an uncertain response. Minor adverse events occurred in 30/280 (10.6%) procedures, and one major complication (0.4%) was reported. Conclusion: TPE is a safe apheresis method in children, even when performed as a long‐term therapy. Efficacy is high under selected conditions. A highly skilled and experienced staff is mandatory to ensure patient safety and efficacy.