Simultaneous Therapeutic Plasma Exchange in Parallel with Cardiopulmonary Bypass for Prevention of HLA-Antibody Mediated Rejection in a Pediatric Double-Transplant Patient

Kazi, Sofia; Carberry, Deborah; Lagarde, Ebben; Wu, Ding Wen

doi:10.7156/najms.2012.054228

Cited by 1 publication

(2 citation statements)

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“…39 We were familiar with case reports utilizing ECMO and CPB circuitry for TPE vascular access; however, the use of external VAD circuitry for TPE vascular access was unknown to us. 25,[40][41][42] Communication with Teru-moBCT (Lakewood, CO) did not provide any additional support for using VAD circuitry for apheresis vascular access (personal communication). Our search of the literature revealed a review article proposing the use of VAD circuitry for TPE access.…”

Section: Discussionmentioning

confidence: 99%

“…Side‐port access to the patient's external VAD circuit was narrow in caliber and made of a flexible plastic material, unlike rigid dialysis catheters made of polyethylene, Teflon or polyurethane that are recommended for emergency and short‐term extracorporeal therapies . We were familiar with case reports utilizing ECMO and CPB circuitry for TPE vascular access; however, the use of external VAD circuitry for TPE vascular access was unknown to us . Communication with TerumoBCT (Lakewood, CO) did not provide any additional support for using VAD circuitry for apheresis vascular access (personal communication).…”

Section: Discussionmentioning

confidence: 99%

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Plasma exchange for heparin‐induced thrombocytopenia in patients on extracorporeal circuits: A challenging case and a survey of the field

Cho

Parilla

Treml

et al. 2018

J of Clinical Apheresis

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Current management of heparin‐induced thrombocytopenia (HIT) involves prompt discontinuation of all heparin products and concomitant initiation of a direct thrombin or anti‐Xa inhibitor for anticoagulation. In the setting of HIT complicated by an urgent need for cardiopulmonary bypass (CPB), the safety and the efficacy of short‐term heparin‐based anticoagulation after therapeutic plasma exchange (TPE) have been previously demonstrated. Patients with HIT requiring TPE are frequently on extracorporeal circuits (either CPB, extracorporeal membrane oxygenation [ECMO] or external ventricular assist devices [VADs]). Performing TPE in parallel with these circuits involves additional consideration for circuit size, anticoagulant/citrate management, as well as flow rates, and risk of air embolus. We report a case of a patient with HIT on external biventricular assist device (BiVAD) requiring urgent CPB who experienced thrombotic and hemolytic complications related to anticoagulation management around apheresis line placement for TPE. We also present results from a national survey of academic apheresis services regarding specific practices in managing patients with HIT on extracorporeal circuits who require TPE. In addition, we demonstrate the utility of TPE in patients with HIT on extracorporeal circuits and the risks of this procedure and the need to develop practice guidelines.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%