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Scope, Safety, and Feasibility of Therapeutic Plasma Exchange in Pediatric Intensive Care Unit: A Single-center
Karthik Kumar Balasubramanian1, Priyavarthini Venkatachalapathy1, Saravanan Margabandhu2
1Department of Paediatric Intensive Care Unit, Apollo Cradle & Children's Hospital, Chennai, Tamil Nadu, India.
Insights
Therapeutic plasma exchange (TPE) is effective for pediatric intensive care unit (PICU) patients with conditions like acute liver failure and thrombotic microangiopathy. While serious adverse events are infrequent, TPE demonstrates a good therapeutic response in most children.
Area of Science:
- Pediatric critical care medicine
- Apheresis techniques
- Extracorporeal therapies
Background:
- Indications for therapeutic plasma exchange (TPE) in the pediatric intensive care unit (PICU) are expanding.
- This study examines the demographics, clinical indications, and outcomes of TPE in PICU patients.
Purpose of the Study:
- To evaluate the scope, safety, and feasibility of therapeutic plasma exchange in a pediatric intensive care unit.
- To analyze patient demographics, clinical indications, and outcomes associated with TPE.
Main Methods:
- Retrospective study of children aged 1 month to 16 years who underwent TPE.
- Data collected included demographics, indications, therapeutic response, serious adverse events (SAEs), PICU length of stay (LOS), and mortality.
- Analysis of 115 TPE sessions across 24 patients for 12 different indications.
Main Results:
- Therapeutic plasma exchange was performed for 12 indications, with thrombotic microangiopathy (TMA) and acute liver failure (ALF) being most common.
- Five serious adverse events (4.3%) and 12 minor adverse events (10.4%) were recorded.
- A good therapeutic response was observed in 71% of patients (17/24), with a 12.5% mortality rate.
Conclusions:
- Therapeutic plasma exchange is an effective treatment for pediatric patients with ALF and TMA.
- TPE demonstrates efficacy across various organ systems and clinical conditions in the PICU.
- While generally safe, serious adverse events can occur in a minority of patients.
Background:
Indications for therapeutic plasma exchange (TPE) in the pediatric intensive care unit (PICU) are expanding. We aimed to study the demographics, clinical indications, and outcomes of patients who have undergone TPE in our PICU.
Materials And Methods:
This is a retrospective study performed among children aged from 1 month to 16 years of age. Demographics, indications, therapeutic response, serious adverse events (SAE), PICU length of stay (LOS), and death during hospitalization were studied as outcome variables.
Results:
Therapeutic plasma exchange was performed in 115 sessions on 24 patients for 12 different indications falling under various American Society for Apheresis (ASFA) categories. Therapeutic plasma exchange was performed on ten, four, and ten children for ASFA category I, II, and III indications, respectively. The most common indications were thrombotic microangiopathy (TMA) (8/24) and acute liver failure (ALF) (6/24). During those 115 sessions, a total of five serious adverse events (SAEs) occurred, accounting for 4.3% of the cases. Minor adverse events occurred in 12 sessions (10.4%). Therapeutic response was good in 17 patients (71%) including 5 patients who underwent standard volume TPE (SV-TPE) for ALF. Median PICU LOS was 9 (range 2-120) days. The mortality rate was 12.5% (3/24).
Conclusion:
Therapeutic plasma exchange is effective in various clinical conditions involving various organ systems. It is an excellent therapeutic modality in children with ALF, irrespective of the exchange volume and TMA. However, SAEs do occur in the minority.
How To Cite This Article:
Balasubramanian KK, Venkatachalapathy P, Margabandhu S, Natraj R, Sridaran VK, Lakshmanan C, et al. Scope, Safety, and Feasibility of Therapeutic Plasma Exchange in Pediatric Intensive Care Unit: A Single-center Experience. Indian J Crit Care Med 2023;27(10):766-770.
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