Combination of plasma exchange and haemofiltration for treating thrombotic microangiopathy in children

Abstract

Objective: To investigate the therapeutic effects of a combination of plasma exchange (PE) and haemofiltration (HF) for the treatment for paediatric patients with severe thrombotic microangiopathy (TMA). Methods: This retrospective study analysed data from paediatric patients who were diagnosed with severe TMA and managed with either supportive therapy and additional PE and HF (PE þ HF group) or supportive therapy alone (control group). Demographic and clinical characteristics, haemopurification and blood parameters and survival of the patients were compared between the two groups. Results: This study enrolled 32 patients: PE þ HF group (n ¼ 15) and control group (n ¼ 17). There were no significant differences between the two groups at baseline, including specific features for differentiating the two categories of TMA. The median time between onset and recovery, defined by the markers of platelet count, lactate dehydrogenase, blood urine nitrogen and hospital stay, were all significantly longer in the control group compared with the PE þ HF group. Kaplan-Meier curve analysis demonstrated that the cumulative survival rate was significantly higher in the PE þ HF group compared with the control group. Conclusion: The combination of PE and HF could be considered as one of the treatment choices for TMA.