Solutions to technical challenges during therapeutic plasma exchange using the Spectra Optia on a 4 kilogram neonate

Therapeutic plasma exchange for life‐threatening pediatric disorders

“…Citrate intolerance, reactions to plasma, kit problems, and venous access complications have often been reported for children and adults. 1,8 In addition, the complexity of venous access and the technique's availability is often responsible for the delay of care, and sometimes indications are not approved by physicians. 7,19 In any case, the early indication and optimal treatment volume are the main success factors for TPE.…”

“…The first TPE series of sessions covered 549 of the 731 procedures. Each patient underwent a median of 6 procedures [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19], with a median volume of 1834 mL [500-5000 mL]; this corresponded to a median total plasma volume equivalent of 1.4 L/m 2 [0.6-2.1 L/m 2 ] (Table 2). The first procedures were performed with peripheral vascular access in only six cases (8%).…”

“…Children require specifically modified protocols and present unique therapeutic challenges due to (a) the immaturity of their metabolism pathways, (b) a lack of cooperation, (c) the difficulty in assessing toxicity, and (d) the extracorporeal circuit management with small body surface areas. 1,8 The present study's objectives were to review, in a pediatric retrospective cohort based on web-based electronic case report form (eCRF), all adverse events (AEs) during TPE. We look primarily at three different groups of diseases usually supported in a pediatric intensive care unit (PICU): antibody-mediated rejection (AMR), thrombotic microangiopathy (TMA), and inflammatory diseases.…”

Safety and efficacy of autologous mononuclear cell and stem cell apheresis in very low‐weight children—Experience at a single center

“…The safety of this procedure in children has been analyzed in a small series of patients, but only single procedures were performed and reported in children less than 10 kg . The experience with Spectra Optia in extremely low weight children was reported in neonatal therapeutical plasma exchange . According to the published reports, the technical difficulties involved in low‐weight apheresis require initial priming of the disposable kit with fluids and blood and then maintaining the blood processing speed to provide both a high‐quality apheresis product and avoid electrolyte imbalances or hemodynamic disorders.…”