Therapeutic plasma exchange in children: One center's experience

Cortina, Gérard; Ojinaga, Violeta; Giner, Thomas; Riedl, Magdalena; Waldegger, Siegfried; Rosales, Alejandra; Trojer, Raphaela; Hofer, Johannes

doi:10.1002/jca.21547

Cited by 22 publications

(35 citation statements)

References 22 publications

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“…In most of the studies investigating TPE utility in pediatric patients, treatment indications were mostly hematologic, neurologic, and renal diseases. While in a study conducted in 18 patients with 280 treatment sessions, 61% of the patients had renal diseases, in another study investigating 288 treatment sessions in 48 patients reported that their patient profile included 30% of hematological diseases and 20% solid organ transplantations . HUS was one of the most frequent renal diseases .…”

Section: Discussionmentioning

confidence: 94%

“…While in a study conducted in 18 patients with 280 treatment sessions, 61% of the patients had renal diseases, in another study investigating 288 treatment sessions in 48 patients reported that their patient profile included 30% of hematological diseases and 20% solid organ transplantations . HUS was one of the most frequent renal diseases . However, since some facilities includes HUS into renal disease, others can categorize HUS into hematological disease group .…”

Section: Discussionmentioning

confidence: 99%

“…Therefore indications and possible complications are based on adult studies. However, it is a highly specialized procedure and should be performed by experienced staff in a specialized center to minimize risk of complications …”

Section: Discussionmentioning

confidence: 99%

“…Therapeutic plasma exchange (TPE) is an extracorporeal therapy being used in a wide spectrum of diseases including various diseases of hematology, nephrology, rheumatology, and neurology and organ transplantation . It is a procedure of plasma removal with its ineligible plasma component; plasma is separated from whole blood and replaced with plasma or albumin.…”

Section: Introductionmentioning

confidence: 99%

“…Although features of the apheresis procedure are technically identical in both adults and children, differences in vascular access and extracorporeal volume cause difficulties in pediatric patients. Even though there are many studies on plasma exchange, indications, and technical problems in adult patients, there are limited resources for the pediatric population …”

Section: Introductionmentioning

confidence: 99%

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Therapeutic plasma exchange in pediatric intensive care: Indications, results and complications

et al. 2020

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Therapeutic plasma exchange (TPE) is an effective treatment method in selective indications. Secondary to access and technical features, it is more difficult to apply in pediatric population than adults. The aim of this study is investigate safety, clinical indications, and results of this method in critically ill pediatric patients who need TPE treatment. All of the TPE procedures performed in a pediatric intensive care unit providing tertiary care during 4 years (2015–2019) were evaluated retrospectively. TPE procedures (635) were performed for 135 patients. Median age was 34 months (10‐108). Ninety‐seven patients had mechanical ventilation support. Sepsis with multiple organ failure was the most frequent indication and accounted for 44.4% (n = 60) of the indications followed by hematological and neurological diseases (19.2% and 9.6% respectively). TPE was performed alone in 469 cases (73.9%), in combination with continuous renal replacement therapy in 154 cases (24.2%), and additional to extracorporeal membrane oxygenation in 12 cases (1.9%). Hematological disease and sepsis subgroups had the highest intubation rate, mechanical ventilation period, PRISM score, organ failure count, and mortality. Fresh frozen plasma (FFP) was the most frequently used replacement fluid in 90.4% of the procedures. The most frequent anticoagulant used in TPE was acid citrate dextrose solution (79.3%). Procedural complications were detected in 104 cases (16.3%) and occurred during TPE sessions. Overall survival rate was 78.5%. We found that the non‐survivor group had significantly higher rates of organ failures (P = 0.0001), higher PRISM scores on admission (P = 0.0001), and higher rates of invasive ventilation support needed (P = 0.012). TPE is a treatment method which can be safely provided in healthcare facilities with necessary medical and technical requirements. Although it is riskier to provide such treatment to critically ill children, complications can be minimized in experienced healthcare facilities. Overall results are good and can vary depending on indication.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Therapeutic plasma exchange in pediatric intensive care: Indications, results and complications

et al. 2020

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Adverse events during apheresis: A 10‐year experience at a tertiary academic medical center

Kundrapu

Datla

Griffin

et al. 2019

J of Clinical Apheresis

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Background: Apheresis can be associated with adverse events (AEs). Available studies published on apheresis-associated AEs lack uniformity of data. Unfortunately, there is no common database in the United States (US) to report apheresis-associated AEs. We evaluated our institutional incidence of apheresis-associated AEs and compared it with published literature. Study design and methods: We conducted a 10-year retrospective study of apheresis procedures and associated AEs at our facility, a tertiary academic medical center, from 2007 to 2016. Concurrently, a literature search was conducted on AEs associated with apheresis procedures. Twenty-eight studies including data from US and other countries' facilities were analyzed. Results: The overall AE incidence was 6.9% (396/5684 procedures). Frequency of AEs associated with therapeutic plasma exchange (TPE) was higher (8.5%, P < .0001) compared to other apheresis procedures. Significant correlation between number of TPE and AEs (Spearman rho [r s ] = 0.7, P = .002) was encountered.Furthermore, there was a significant decrease over time of moderate and severe AEs (r s = −0.64, P = .04 and r s = −0.83, P = .003 respectively). Comparison of our institutional AEs (6.9%) to data from other countries (9.8%) and US (22.6%) indicated a significant difference (P < .0001). Conclusion: Overall our incidence of AEs was significantly lower than current published literature. Incidence of AEs published in other countries is significantly lower than US rates. Differences in incidence of AEs emphasize need for uniform reporting and stratification of AEs and development of a common database to report AEs. Therefore, we propose a grading rationale in order to standardize reporting of AEs. K E Y W O R D S adverse events, apheresis, complications, hematopoietic stem cell collection, red cell exchange, therapeutic plasma exchange

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Membrane‐filtration based plasma exchanges for atypical hemolytic uremic syndrome: Audit of efficacy and safety

Khandelwal

Thomas

Rathi

et al. 2019

J of Clinical Apheresis

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Background: While complement blockade with eculizumab is recommended as first-line therapy of atypical hemolytic uremic syndrome (aHUS), plasma exchanges (PEX) remain the chief option for anti-factor H (FH) antibody associated disease and when access to eculizumab is limited. Methods: We reviewed adverse events (AEs) and adverse outcomes (eGFR <30 mL/min/1.73 m 2 or death), in all patients with aHUS managed with membranefiltration based PEX at one tertiary care center over 5.5 years. Results: During January 2013 to June 2018, 109 patients with aHUS (74 with antibodies to FH), aged median (range) 7.6 (0.5-18) year weighing 22.1 (6-90) kg, underwent 2024 sessions of PEX. AE, in 12.1% patients, were usually self-limiting and included chills (5.5%), vomiting/abdominal pain (3.3%), hypotension (1.6%), urticaria (1.5%), seizures (0.2%), hypocalcemia (0.2%), and hemorrhage (0.1%); plasma hypersensitivity and severe reactions were rare. Rate of catheter-related infections was 1.45/1000 catheter-days. Filter reuse (OR 1.69; 95% CI 1.26-2.26; P < .001) and >20 sessions of PEX/patient (OR 1.99; 95% CI 1.27-3.10; P = .002) were independently associated with adverse events; infusion of IV calcium gluconate during PEX was protective (OR 0.26; 95% CI 0.16-0.43; P < .001). Hematological remission was achieved in 96.3% patients after 6 (5-8) PEX sessions; 80.8% and 89.6% patients were dialysis independent by one and 3 months, respectively. Conclusions: PEX is safe and associated with satisfactory short-term outcomes in children with aHUS. Prolonged PEX and filter-reuse are associated with complications.

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Therapeutic plasma exchange in children: One center's experience

Abstract: 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.

Cited by 22 publications

References 22 publications

Therapeutic plasma exchange in pediatric intensive care: Indications, results and complications

Therapeutic plasma exchange in pediatric intensive care: Indications, results and complications

Adverse events during apheresis: A 10‐year experience at a tertiary academic medical center

Membrane‐filtration based plasma exchanges for atypical hemolytic uremic syndrome: Audit of efficacy and safety

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