Pediatric therapeutic plasma exchange: A comparative assessment of membrane and centrifugal techniques

Therapeutic plasma exchange (TPE) is a critical extracorporeal procedure for removing pathogenic substances from plasma, commonly used in autoimmune, hematologic, and neurological disorders. While both membrane-based (mTPE) and centrifugal TPE (cTPE) are effective, comparative data in pediatric patients remain limited.

This retrospective study analyzed 94 TPE procedures performed at a tertiary hospital between August 2023 and December 2024.

Patients underwent either cTPE (36.2 %) or mTPE (63.8 %), with fresh frozen plasma as the primary replacement fluid. cTPE was associated with shorter procedure duration and greater lactate reduction (p < 0.001, p = 0.003, respectively), whereas mTPE required higher blood flow rates. No significant differences were observed in hemoglobin, hematocrit, platelet counts, or coagulation parameters. Complications occurred in 56.4 % of cases, with hypotension exclusively in cTPE and circuit clotting only in mTPE.

Although both methods showed similar efficacy in laboratory parameters, cTPE was found to be more advantageous in terms of processing time and lactate level reduction. Procedural differences and divergence in complication profiles highlight the importance of individualized method selection based on patient characteristics. Future multi-center studies with standardized protocols are essential to optimize pediatric TPE strategies and improve clinical outcomes.