Therapeutic apheresis in childhood

Area of Science:

• Pediatric Nephrology
• Pediatric Hematology
• Apheresis Procedures

Background:

• Intensive plasma exchange (IPE) and cytopheresis (CY) are established therapeutic apheresis techniques.
• Adaptations are necessary for safe and effective application in pediatric populations.
• Previous experience with pediatric apheresis is limited, particularly for very young or small children.

Purpose of the Study:

• To evaluate the safety and efficacy of modified IPE and CY procedures in children.
• To establish guidelines for performing apheresis in pediatric patients.
• To assess the feasibility of apheresis in children of varying ages and medical conditions.

Main Methods:

• Review of over 2,000 IPE and CY procedures performed over 11 years in children aged 11 months to 18 years.
• Primary anticoagulation method: heparinization.
• Use of red cell-saline prime for acutely ill, anemic, or small patients.

Main Results:

• Minimal to nonexistent morbidity associated with the procedures.
• Successful application across a wide age range (11 months to 18 years).
• Effective anticoagulation achieved with heparinization.

Conclusions:

• Modified IPE and CY procedures are safe and well-tolerated in pediatric patients.
• Apheresis should be considered for pediatric patients regardless of size or concurrent medical issues if indicated.
• Heparinization is a suitable anticoagulation method for pediatric apheresis.