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Therapeutic plasma exchange in children: One center's experience
Author(s) -
Cortina Gerard,
Ojinaga Violeta,
Giner Thomas,
Riedl Magdalena,
Waldegger Siegfried,
Rosales Alejandra,
Trojer Raphaela,
Hofer Johannes
Publication year - 2017
Publication title -
journal of clinical apheresis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.697
H-Index - 46
eISSN - 1098-1101
pISSN - 0733-2459
DOI - 10.1002/jca.21547
Subject(s) - medicine , thrombotic microangiopathy , apheresis , context (archaeology) , therapeutic plasma exchange , adverse effect , complication , surgery , single center , pediatrics , paleontology , platelet , disease , biology
Background Therapeutic plasma exchange (TPE) has evolved to an accepted therapy for selected indications. However, it is technically challenging in children. Moreover, data on safety and efficacy are mainly derived from adult series. The aim of this study was to review the procedure in the context of clinical indications, effectiveness, and safety. Study Design and Methods All TPE procedures performed at a tertiary care hospital during a 12‐year period (2005–2016) were retrospectively evaluated. Results Eighteen patients with a median age of 8.5 (0.2–17) years underwent a total of 280 TPE sessions. Eleven (61%) patients were treated for renal diseases. Three (17%) patients were diagnosed with neurological diseases, two had liver failure, and one patient each had sepsis and stem cell transplant‐associated thrombotic microangiopathy. Seven patients (39%) were classified as American Society for Apheresis Category I, four (22%) as Category II, two (13%) each as Category III and IV, and two (13%) were not classified. Two patients with atypical hemolytic‐uremic syndrome received TPE as long‐term therapy over 2 and 5 years. All procedures were performed using the filtration technique and heparin anticoagulation. Twelve (67%) patients showed full or partial recovery after TPE, six had no response or an uncertain response. Minor adverse events occurred in 30/280 (10.6%) procedures, and one major complication (0.4%) was reported. Conclusion 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.