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Assessing safety and efficacy of therapeutic plasma exchange in pediatric patients: A single-center experience
Mohit Chowdhry1, P J Mutjhukamaravel1, Soma Agrawal1
1Department of Transfusion Medicine, Indraprastha Apollo Hospitals, New Delhi, India.
Insights
Therapeutic plasma exchange (TPE) is effective and safe in children for various conditions. This study shows positive outcomes in pediatric patients, supporting TPE as a valuable treatment option.
Area of Science:
- Pediatric Nephrology
- Immunology
- Critical Care Medicine
Background:
- Therapeutic plasma exchange (TPE) removes toxic plasma components but data in children is limited.
- Pediatric TPE is challenging due to small circulating volumes.
- This study evaluates TPE in pediatric patients.
Purpose of the Study:
- To assess the clinical indications, efficacy, and safety of TPE in children.
- To analyze TPE procedure details in a pediatric cohort.
- To contribute pediatric-specific data on TPE outcomes.
Main Methods:
- Retrospective review of pediatric patients (<18 years) undergoing TPE.
- Analysis of TPE frequency, vascular access, replacement fluid, and instruments.
- Evaluation of plasma volume processed, priming, adverse events, and patient outcomes.
Main Results:
- 114 TPE procedures were performed on 24 pediatric patients.
- Fifteen patients with Category I indications achieved target ABO titers and/or reduced donor-specific antibodies.
- The study demonstrated positive clinical outcomes in selected pediatric cases.
Conclusions:
- Therapeutic plasma exchange is an effective treatment for specific pediatric disorders.
- TPE demonstrated safety and efficacy in the pediatric population studied.
- This data supports TPE as a viable therapeutic option for children.
Introduction:
Therapeutic plasma exchange has been widely employed by clinicians for removal of the toxic constituents from plasma by filtration of whole blood and subsequent removal of plasma and reinfusion of cellular components along with a replacement fluid. It has become an accepted therapeutic modality in paediatric patients for numerous indications including but not limited to renal transplant, haemolytic uremic syndrome and Guillain Barre Syndrome. But, data on safety and efficacy are mainly derived from studies in the adult population with very limited data available in the paediatric age group. However, it is technically challenging in children due to their small circulating volume. This study discusses the clinical indications, efficacy, and safety of therapeutic plasma exchange in paediatric population.
Method:
We retrospectively reviewed the data of children (up to 18 years of age) who underwent TPE between January 2017 and March 2019 at our Hospital. Main features of the TPE procedures i.e. frequency of TPE, site of vascular access, type of replacement fluid used, instrument used, plasma volume processed, priming of the circuit, adverse events if any and outcome of the patients were analysed.
Results And Conclusion:
A total of 114 procedures were performed on these 24 patients. Fifteen patients with Category I indication showed good clinical outcome in terms of attainment of target ABO titre and/or decrease in the donor specific antibody. TPE is an effective therapeutic option in selected paediatric disorders. Our series of data on TPE procedures from paediatric perspective has shown safety and efficacy of the therapy.
