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Feasibility of Pediatric Plasma Apheresis in Intensive Care Settings
Author(s) -
Haque Anwarul,
Sher Gul,
Hoda Mehar,
Moiz Bushra
Publication year - 2014
Publication title -
therapeutic apheresis and dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.415
H-Index - 53
eISSN - 1744-9987
pISSN - 1744-9979
DOI - 10.1111/1744-9987.12173
Subject(s) - medicine , apheresis , thrombotic thrombocytopenic purpura , pediatrics , plasmapheresis , intensive care unit , context (archaeology) , population , fresh frozen plasma , pediatric intensive care unit , intensive care , intensive care medicine , paleontology , platelet , environmental health , antibody , immunology , biology
Therapeutic plasma apheresis or exchange ( TPE ) in the pediatric population is technically challenging. Moreover, there is generally an apprehension in using TPE in children compared to adults. Recently, usage of TPE has evolved and is now being used in heterogenous clinical conditions. Its usefulness is classified by the A merican S ociety for A pheresis ( ASFA ) into various categories ranging from I to IV . The objective of this paper was to review the procedure in context of clinical indications, complications and outcomes in children. For this purpose, we retrospectively reviewed all TPE procedures performed on inpatients of 3 to 16 years of age during a 6‐year period (2007–2012). A total of 130 procedures were performed on 28 patients ( M : F ratio of 1:1) with median age (range) of 8.8 (4–16) years. All procedures were done using the continuous cell‐separator centrifugal method. Due to organ dysfunctions, the majority of procedures ( N = 26 of 28 or 92% patients) were performed in the pediatric intensive care unit. Twenty‐three, four and one patient belonged to ASFA categories I , II and III, respectively. The most common indications were neurological disorders ( N = 13 or 46.4%), comprised of G uillain– B arré syndrome ( N = 10) and myasthenia gravis ( N = 3). Hematological disorders ( N = 10 or 35.7%) including thrombotic thrombocytopenic purpura‐hemolytic uremic syndrome were a close second. Complete recovery was seen in 23 patients (84%). Trivial adverse effects were observed in 18/130 (13.8%) procedures. Major complications including cardiac arrest, hypotension and transfusion‐related acute lung injury were observed in 5/130 or 3.8% of procedures. However, there was no procedure‐related death though five patients died during treatment due to underlying pathology. In conclusion, TPE is a safe and effective option in sick children for appropriate indications. An experienced staff with sound procedural skills is imperative for successful therapy.