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[Clinical aspects of plasmapheresis therapy in children: single center experience]
Abstract:
Data concerning 576 plasmapheresis sessions (indications, anticoagulation applied, supplement type and acute complications) in children (mean body weight = 35 kg +/- 15; min 5 kg, max 75 kg) performed between 1990 and 2001 were analysed.
Indications:
Glomerulonephritis (GN)--185 (32%) (including recurrence after kidney transplantation--108, rapidly progressive GN--63, other GN--14), other immunological diseases--110 (19%) (systemic lupus erythematosus, Wegener's granulomatosis, myasthenia, Guillain-Barré syndrome, other), haemolytic-uraemic syndrome--104 (18%) (after kidney transplantation--50, atypical--54), Amanita poisoning 100 (17%), acute hepatic encephalopathy--41 (7%) (after liver transplantation--9), poisoning with drugs bound by plasma albumin--22 (4%) and complications in kidney graft recipients--14 (2%) (acute vascular rejection, parathormone toxicity).
Anticoagulation:
Until the end of 1999--unfractionated heparin (in divided doses every 30 min--100 IU/kg/session on the average), from 2000 on--single dose of Fraxiparine (mean 70 IU anty-Xa/kg/session).
Supplement:
Until 1995--Ringer solution + fresh frozen plasma, from 1996 on--Ringer solution + fresh frozen plasma or 4% albumin solution diluted in 5% dextrose (depending on indications, contraindications and fibrinogen concentration).
Complications:
Deaths in the course of plasmapheresis--0, others (rash, abdominal pain, headache, nausea and vomiting, blepharoedema, drop of arterial pressure, pruritus)--19 (3%), necessity of session termination because of patient condition (dyspnoea, urticaria, hypotension)--3 (0.5%) and technical problems--23 (4.5%) (filter damage--8, filter clotting--5, haemolysis--3, machine malfunction--5, problems with vascular access--2).