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Exchange blood transfusion and on-line plasma exchange for sepsis in infants
Y Asanuma1, T Takahashi, K Koyama
1Akita University School of Medicine, Japan.
Insights
Exchange blood transfusions for infant sepsis show promise but face antibody issues. A new on-line plasma exchange (PE) system using a canine model demonstrated improved survival and reduced bacterial load in septic puppies.
Area of Science:
- Neonatal care
- Infectious diseases
- Medical device development
Background:
- Sepsis in infants is a life-threatening condition.
- Exchange blood transfusions (EBT) have been used for infant sepsis with limited success due to antibody formation against white blood cells (WBCs) and platelets.
- A novel on-line plasma exchange (PE) system was developed to overcome EBT limitations.
Purpose of the Study:
- To evaluate the efficacy and applicability of a miniature on-line plasma exchange (PE) system for treating sepsis.
- To assess the impact of PE on bacterial load, endotoxin levels, and opsonic activity in a sepsis model.
Main Methods:
- A canine model was used to simulate infant sepsis.
- Escherichia coli was intravenously injected into 17 puppies, which were then divided into untreated, sham-treated, and PE groups.
- In the PE group, 80 ml/kg of plasma was exchanged over 2 hours with fresh plasma from healthy adult dogs.
Main Results:
- The PE group showed a survival rate of 80% (4 out of 5 puppies), while all puppies in the other groups died within 24 hours.
- PE treatment led to a significant decrease in viable E. coli counts and endotoxin levels.
- Opsonic activity in the plasma of treated puppies significantly improved.
Conclusions:
- The developed miniature on-line plasma exchange system is effective in treating sepsis.
- This PE system demonstrates potential applicability for treating sepsis in infants, offering improved outcomes compared to traditional methods.
Abstract:
During the last 6 years, 19 infants with sepsis have been treated with exchange blood transfusions 47 times, and 13 patients survived. However, this procedure is compromised by antibody formation against WBCs and platelets. Accordingly, a miniature system for on-line plasma exchange (PE) between septic infant and healthy parent has been developed and evaluated using a canine model. Escherichia coli, at a dose of 5 X 10(9) CFU/ml/kg, was injected intravenously into 17 puppies that were divided into 3 groups; untreated; sham treated; and PE in which 80 ml/kg of plasma in each septic puppy was replaced during 2 hr with fresh plasma simultaneously obtained from healthy adult dogs. Four of 5 puppies survived in the PE group, while all other puppies died within 24 hr. In the PE group, viable cell counts of E. coli and endotoxin decreased significantly, and opsonic activity improved. This system is effective and applicable for treatment of sepsis in infants.