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Exchange transfusion in Reye's syndrome with saline-washed red blood cells
Insights
Exchange transfusion using saline-washed red blood cells and fresh frozen plasma offers a safe and effective treatment for Reye's syndrome (RS). This method improves survival rates in children with severe encephalopathy, easing the strain on blood resources.
Area of Science:
- Pediatric Medicine
- Hematology
- Toxicology
Background:
- Reye's syndrome (RS) is a severe childhood illness characterized by encephalopathy and fatty visceral degeneration.
- Traditional treatments have shown limited success, and fresh blood for exchange transfusion (ET) poses resource challenges.
Purpose of the Study:
- To evaluate the efficacy and safety of using saline-washed red blood cells (RBCs) and fresh frozen plasma (FFP) for ET in Reye's syndrome patients.
- To determine if this modified ET approach can improve survival rates and reduce reliance on fresh blood.
Main Methods:
- Exchange transfusion (ET) using saline-washed RBCs (less than six days old) and fresh frozen plasma (FFP).
- Treatment of nine pediatric patients with severe encephalopathy due to Reye's syndrome.
- Continuous computerized electroencephalogram (EEG) monitoring in five patients.
Main Results:
- Eight out of nine patients survived without sequelae following treatment.
- The age of blood used did not impact the number of exchanges or patient outcomes.
- Continuous EEG monitoring provided objective evidence of ET's effectiveness.
Conclusions:
- Exchange transfusion with saline-washed RBCs and FFP is a safe, fast, and effective treatment for Reye's syndrome.
- This method alleviates the strain on blood bank resources while improving patient survival.
- The approach offers a viable alternative for managing severe pediatric cases of Reye's syndrome.
Abstract:
Reye's syndrome (RS) consists of encephalopathy, fatty degeneration of viscera, and elevation of ammonia, certain amino acids, and liver enzymes in the blood. It is most characteristically a disease of children and has been considered to have a poor prognosis despite the use of various treatment regimens. Exchange transfusion (ET) with fresh blood (less than 24 hours old) for the removal of toxic metabolic byproducts in TS is a relatively recent development which appears to have improved the survival rates. However, because RS may occur in epidemic proportions at any time the demand for fresh blood can place an excessive stress on blood resources. We have, therefore, utilized saline-washed (to remove potentially toxic metabolites) red blood cells (RBC's) less than six days old, and fresh frozen citrate-phosphate-dextrose (CPD) plasma in treating this disorder. Nine patients in the Milwaukee community with severe encephalopathy secondary to RS were treated with ET. These patients collectively required 151 units of washed RBC's for 21 ET. Eight of nine patients survived without sequelae. Age of blood used did not correlate with the number of exchanges required or the eventual outcome. A continual computerized EEG in five patients provided objective evidence of the effectiveness of ET. We conclude that ET with saline-washed RBC's reconstituted with fresh frozen plasma (FFP) is a fast, safe, and effective means of treating patients with RS.