World apheresis registry data from 2003 to 2007, the pediatric and adolescent side of the registry

Witt, Volker; Stegmayr, Bernd; Pták, Jan; Wíkström, Björn; Berlin, Gösta; Axelsson, C. G.; Griskevicius, A.; Centoni, Paolo Emilio; Liumbruno, Giancarlo Maria; Molfettini, Pietra; Audzijoniene, J.; Mokvist, K; Sojka, Birgitta Nilsson; Norda, Rut; Ramlow, Wolfgang; Bláha, M.; Evergren, M.; Tomaz, J.

doi:10.1016/j.transci.2008.09.001

Cited by 54 publications

(55 citation statements)

References 21 publications

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“…During the past decade, experience with plasmapheresis has become widespread in pediatric intensive care units and nephrology units throughout the world [1,2]. The indications for plasma therapy are varied, ranging from the treatment of autoimmune and rheumatologic diseases, hematologic disorders, and renal and neurologic diseases, drug removal, and support for inborn error metabolism, liver failure, and sepsis [1][2][3][4].…”

Section: Introductionmentioning

confidence: 99%

“…The indications for plasma therapy are varied, ranging from the treatment of autoimmune and rheumatologic diseases, hematologic disorders, and renal and neurologic diseases, drug removal, and support for inborn error metabolism, liver failure, and sepsis [1][2][3][4]. Commonly encountered problems in pediatric apheresis therapy are the management of anticoagulation, restricted possibilities for venous access, and disproportion of extracorporeal volume in comparison to the patient's blood volume [1].…”

Section: Introductionmentioning

confidence: 99%

“…For extracorporeal procedures, one should contemplate an alternative to systemic anticoagulation in patients with an increased risk of hemorrhagic complications or with overt bleeding [6][7][8]. Although, regional citrate anticoagulation (RCA) has been considered as a standard procedure in pediatric apheresis therapy for more than a decade [1][2][3], there have been very few published reports on dosing recommendations as well as few; evaluations of effectiveness and safety. Most of the data currently available on anticoagulation in pediatric apheresis are on stem cell harvesting in healthy donors and cytapheresis [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

“…Most of the data currently available on anticoagulation in pediatric apheresis are on stem cell harvesting in healthy donors and cytapheresis [9][10][11]. In an Italian registry, over 90% of pediatric patients received RCA in 2005 [11], and 71% of apheresis sessions reported to the "world apheresis registry" were performed using RCA [1]. However, a number of difficulties are associated with apheresis therapy with RCA due to the absence of relevant clearance of citrate and/or fluid, thereby increasing the risk of citrate accumulation and intoxication.…”

Section: Introductionmentioning

confidence: 99%

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Regional citrate anticoagulation—a safe and effective procedure in pediatric apheresis therapy

et al. 2010

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Regional citrate anticoagulation (RCA) has been considered to be a standard component of pediatric apheresis therapy for more than a decade. However, data on dosing recommendations and evaluations of the effectiveness and safety of anticoagulation are rarely found in published reports. The aim of this retrospective analysis was to present our single-center experience with RCA in pediatric apheresis therapy with the aim of developing an operating procedure. Five children aged 7-14 years underwent a total of 72 (range 3-44) therapeutic apheresis sessions with RCA in the form of immunoadsorption therapy (2 patients), low-density lipoprotein (LDL)-apheresis (1 patient), and plasmapheresis (two patients). A 3% citrate solution was used. Citrate flow was started at 4.0% of the blood flow velocity and was adapted to match post-filter ionized calcium levels ≤ 0.30 mmol/l. Once the patient's ionized calcium fell to <1.05 mmol/l, an intravenous 10% calcium gluconate solution was administered. Twenty pediatric apheresis patients who received standard heparinization, matched for age, body surface area, processed plasma volume, and blood flow velocity, were enrolled in the study as a comparison group. No side effects were experienced in 72 apheresis session. The 3% citrate solution had to be reduced gradually during the apheresis session and was infused at a mean of 2.8-3.8% of the blood flow rate. Serum bicarbonate levels before and after the apheresis session with RCA [23.9 (range 18.9-30.1) vs. 26.3 (20.2-33.0) mmol/l, respectively] were significantly different (p=0.013). All patients required intravenous calcium substitution to maintain serum calcium levels within the physiological range. Due to the administration of the 3% citrate solution and calcium, all patients significantly gained weight during the procedure, with a median weight gain of 2.5% (p<0.001). The extra fluid load caused problems in patients with kidney failure. Our regimen with RCA is safe, feasible, and effective in pediatric therapeutic apheresis therapy. For RCA in apheresis, we recommend (1) a citrate (3%) flow of 3.3% of the blood flow, (2) prophylactic intravenous calcium substitution from the beginning, and (3) a more highly concentrated citrate solution in the case of oliguric patients.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Regional citrate anticoagulation—a safe and effective procedure in pediatric apheresis therapy

et al. 2010

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“…PE is technically challenging and requires specialized centres, especially for children [91][92][93]. The most frequent complications are hypotension, hypocalcemia, catheter-related thrombosis and infections, all more frequent in children than in adults (55% of sessions in children vs 4.3 to 28% in adults [92]).…”

Section: Limits Of Plasmatherapymentioning

confidence: 99%

Management of hemolytic uremic syndrome

2012

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Therapeutic apheresis in pediatrics: Technique adjustments, indications and nonindications, a plasma exchange focus

Wong

Balogun

2012

J of Clinical Apheresis

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Therapeutic Apheresis procedures are associated with multiple and unique challenges in children. The procedures are often performed using evidence or experience extrapolated from adult clinical practice, which may not be evidenced based. In addition to the clinical challenges, relevant psychological issues, modification of protocols and technical hardware are often necessary for safe and effective treatment in children. The following review addresses these aspects of therapeutic apheresis in children as presented at the Therapeutic Apheresis Academy in September 2011. Because of the variety of therapeutic apheresis procedures that can be performed in children, for the purposes of this review, an emphasis will be on the performance of plasma exchange in children.

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World apheresis registry data from 2003 to 2007, the pediatric and adolescent side of the registry

Cited by 54 publications

References 21 publications

Regional citrate anticoagulation—a safe and effective procedure in pediatric apheresis therapy

Regional citrate anticoagulation—a safe and effective procedure in pediatric apheresis therapy

Management of hemolytic uremic syndrome

Therapeutic apheresis in pediatrics: Technique adjustments, indications and nonindications, a plasma exchange focus

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