Hematologic Disorders in Children with Continuous Renal Replacement Therapies

Area of Science:

• Pediatric Nephrology
• Critical Care Medicine
• Hematology

Background:

• Continuous renal replacement therapy (CRRT) is crucial for critically ill children but can impact hematologic and coagulation systems.
• Understanding these changes is vital for optimizing patient management and transfusion strategies.

Purpose of the Study:

• To analyze hematologic disorders, coagulation changes, and transfusion requirements in pediatric patients undergoing CRRT.
• To compare these outcomes based on patient subgroups (cardiac vs. non-cardiac surgery, ECMO use) and anticoagulation methods (heparin vs. citrate).

Main Methods:

• Retrospective analysis of a prospectively collected database of 87 children receiving CRRT between 2010 and 2015.
• Recorded and analyzed patient characteristics, CRRT parameters, hematologic and coagulation markers, and transfusion needs.
• Compared outcomes between cardiac and non-cardiac surgery patients, those with and without ECMO, and those on heparin versus citrate anticoagulation.

Main Results:

• CRRT was associated with a significant decrease in hematocrit (33.6% to 30.3%) and platelet count (159,291 to 101,163).
• Coagulation parameters improved, with decreased international normalized ratio (1.5 to 1.2) and increased fibrinogen (328 to 437 mg/dL).
• Ninety percent of patients received blood products; those requiring ECMO or who deceased had significantly higher transfusion needs. No significant differences were found between cardiac/non-cardiac groups or heparin/citrate anticoagulation.

Conclusions:

• Children undergoing CRRT exhibit hematologic changes, including decreased hematocrit and platelets, necessitating substantial blood product transfusions.
• Patients on ECMO and those with fatal outcomes require the most transfusions, highlighting their critical status.