Therapeutic Plasma Exchange Application in Children Requires Individual Decision

Abstract

Therapeutic plasma exchange (TPE) is a treatment administered with the aim of removing a pathogenic material or compound causing morbidity in a variety of neurologic, hematologic, renal, and autoimmune diseases. In this study, we aimed to assess the indications, efficacy, reliability, complications, and treatment response of pediatric patients for TPE. This retrospective study analyzed data from 39 patients aged from 0 to 18 years who underwent a total of 172 TPE sessions from January 2015 to April 2018 in a tertiary pediatric intensive care unit. Indications for TPE were, in order of frequency, macrophage activation syndrome (28.2%, n = 11), renal transplantation rejection (15.4%, n = 6), liver failure (15.4%, n = 6), Guillain–Barre's syndrome (15%, n = 6), hemolytic uremic syndrome (7.7%, n = 3), acute demyelinating disease (7.7%, n = 3), septic shock (5.1%, n = 2), and intoxication (5.1%, n = 2). No patient had any adverse event related to the TPE during the procedure. The TPE session was ended prematurely in one patient due to insufficient vascular access and lack of blood flow (2.6%). In the long term, thrombosis due to the indwelling central catheter occurred (5.1%, n = 2). TPE appears to be an effective first-stage or supplementary treatment in a variety of diseases, may be safely used in pediatric patients, and there are significant findings that its area of use will increase. In experienced hands and when assessed carefully, it appears that the rate of adverse reactions and vascular access problems may be low enough to be negligible.

Keywords

therapeutic plasma exchange - pediatric - indications

Ethical Approval

This study was performed with the approval of the Clinical Research Ethics Committee. Since it was a retrospective case–control study, no informed consent was taken. This article does not contain any studies with animals performed by any of the authors.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Publication History

Received: 03 April 2020

Accepted: 03 June 2020

Article published online:
20 July 2020

• References

• 1 Strauss RG, Ciavarella D, Gilcher RO. et al. An overview of current management. J Clin Apher 1993; 8 (04) 189-194
• 2 Gorlin JB. Therapeutic plasma exchange and cytapheresis in pediatric patients. Transfus Sci 1999; 21 (01) 21-39
• 3 Elder AF, Kim HC. Pediatric therapeutic apheresis. In: Herman JH, Manno CS. eds. Pediatric Transfusion Therapy. Bethesda, MD: AABB Press; 2002: 471-508
• 4 McLeod BC, Kim HC. Therapeutic apheresis. In: Hillyer C, Strauss R, Luban N. eds. Handbook of Pediatric Transfusion Medicine. San Diego, CA: Elsevier Academic Press; 2004: 343-352
• 5 Eder AF, Kim HC. Therapeutic cytapheresis. In: Hillyer C, Strauss R, Luban N. eds. Handbook of Pediatric Transfusion Medicine. San Diego, CA: Elsevier Academic Press; 2004: 353-364
• 6 Cortese I, Chaudhry V, So YT, Cantor F, Cornblath DR, Rae-Grant A. Evidence-based guideline update: plasmapheresis in neurologic disorders: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2011; 76 (03) 294-300
• 7 Schwartz J, Padmanabhan A, Aqui N. et al. Guidelines on the use of therapeutic apheresis in clinical practice-evidence-based approach from the writing committee of the American Society for Apheresis: the seventh special issue. J Clin Apher 2016; 31 (03) 149-162
• 8 Paternostro-Sluga T, Grim-Stieger M, Posch M. et al. Reliability and validity of the Medical Research Council (MRC) scale and a modified scale for testing muscle strength in patients with radial palsy. J Rehabil Med 2008; 40 (08) 665-671
• 9 Gajjar M, Patel T, Bhatnagar N, Solanki M, Patel V, Soni S. Therapeutic plasma exchange in pediatric patients of Guillain-Barre syndrome: experience from a tertiary care centre. Asian J Transfus Sci 2016; 10 (01) 98-100
• 10 Demirkol D, Yildizdas D, Bayrakci B. et al; Turkish Secondary HLH/MAS Critical Care Study Group. Hyperferritinemia in the critically ill child with secondary hemophagocytic lymphohistiocytosis/sepsis/multiple organ dysfunction syndrome/macrophage activation syndrome: what is the treatment?. Crit Care 2012; 16 (02) R52
• 11 Sandoglobulin Guillain-Barre Syndrome Trial Group. Randomised Trial of Plasma exchange, intravenous immunoglobulin and combined treatments in GuillainBarre Syndrome. Plasma exchange/Sandoglobulin Guillain-Barre Syndrome Trial Group. Lancet 1997; 349: 225-230
• 12 Gafoor VA, Jose J, Saifudheen K, Musthafa M. Plasmapheresis in neurological disorders: experience from a tertiary care hospital in South India. Ann Indian Acad Neurol 2015; 18 (01) 15-19
• 13 Clemmesen JO, Kondrup J, Nielsen LB, Larsen FS, Ott P. Effects of high-volume plasmapheresis on ammonia, urea, and amino acids in patients with acute liver failure. Am J Gastroenterol 2001; 96 (04) 1217-1223
• 14 Larsen FS, Hansen BA, Ejlersen E. et al. Cerebral blood flow, oxygen metabolism and transcranial Doppler sonography during high-volume plasmapheresis in fulminant hepatic failure. Eur J Gastroenterol Hepatol 1996; 8 (03) 261-265
• 15 Larsen FS, Schmidt LE, Bernsmeier C. et al. High-volume plasma exchange in patients with acute liver failure: an open randomised controlled trial. J Hepatol 2016; 64 (01) 69-78
• 16 Schaefer B, Schaefer F, Engelmann G. et al. Comparison of Molecular Adsorbents Recirculating System (MARS) dialysis with combined plasma exchange and haemodialysis in children with acute liver failure. Nephrol Dial Transplant 2011; 26 (11) 3633-3639
• 17 Kıhtır HS, Yeşilbaş O, Kıhtır Z, Yıldırım HM, Şevketoğlu E. Pediatric olanzapine poisoning and plasma exchange in one case: four case reports. J Med Surg Intensive Care Med 2016; 7: 34-38
• 18 Michon B, Moghrabi A, Winikoff R. et al. Complications of apheresis in children. Transfusion 2007; 47 (10) 1837-1842
• 19 Sigler K, Lee J, Srivaths P. Regional citrate anticoagulation with calcium replacement in pediatric apheresis. J Clin Apher 2018; 33 (03) 274-277