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Therapeutic plasma exchange in children: One center's experience
Gerard Cortina1, Violeta Ojinaga1, Thomas Giner1
1Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria.
Insights
Therapeutic plasma exchange (TPE) is safe and effective in children for various conditions, including kidney diseases. Experienced staff are crucial for successful outcomes in this pediatric apheresis procedure.
Area of Science:
- Pediatric Nephrology
- Apheresis Techniques
- Critical Care Medicine
Background:
- Therapeutic plasma exchange (TPE) is an established treatment for specific conditions.
- Its application in pediatric patients presents unique technical challenges.
- Existing safety and efficacy data primarily originate from adult studies.
Purpose of the Study:
- To review the procedure of therapeutic plasma exchange in children.
- To evaluate clinical indications, effectiveness, and safety in a pediatric population.
- To assess TPE's role in managing pediatric diseases.
Main Methods:
- Retrospective evaluation of all TPE procedures performed over a 12-year period (2005-2016).
- Analysis included patient demographics, indications, procedure details, and outcomes.
- Data were collected from a tertiary care hospital setting.
Main Results:
- Eighteen pediatric patients (median age 8.5 years) underwent 280 TPE sessions.
- Renal diseases were the primary indication (61%), followed by neurological diseases and liver failure.
- Sixty-seven percent of patients showed full or partial recovery; minor adverse events occurred in 10.6% of procedures, with one major complication (0.4%).
Conclusions:
- Therapeutic plasma exchange is a safe apheresis method for pediatric patients, including long-term therapy.
- TPE demonstrates high efficacy in selected pediatric conditions.
- Ensuring patient safety and treatment efficacy necessitates highly skilled and experienced healthcare staff.
Background:
Therapeutic plasma exchange (TPE) has evolved to an accepted therapy for selected indications. However, it is technically challenging in children. Moreover, data on safety and efficacy are mainly derived from adult series. The aim of this study was to review the procedure in the context of clinical indications, effectiveness, and safety.
Study Design And Methods:
All TPE procedures performed at a tertiary care hospital during a 12-year period (2005-2016) were retrospectively evaluated.
Results:
Eighteen patients with a median age of 8.5 (0.2-17) years underwent a total of 280 TPE sessions. Eleven (61%) patients were treated for renal diseases. Three (17%) patients were diagnosed with neurological diseases, two had liver failure, and one patient each had sepsis and stem cell transplant-associated thrombotic microangiopathy. Seven patients (39%) were classified as American Society for Apheresis Category I, four (22%) as Category II, two (13%) each as Category III and IV, and two (13%) were not classified. Two patients with atypical hemolytic-uremic syndrome received TPE as long-term therapy over 2 and 5 years. All procedures were performed using the filtration technique and heparin anticoagulation. Twelve (67%) patients showed full or partial recovery after TPE, six had no response or an uncertain response. Minor adverse events occurred in 30/280 (10.6%) procedures, and one major complication (0.4%) was reported.
Conclusion:
TPE is a safe apheresis method in children, even when performed as a long-term therapy. Efficacy is high under selected conditions. A highly skilled and experienced staff is mandatory to ensure patient safety and efficacy.
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