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Plasma Exchange in the Setting of Immune-Mediated Multiple Organ Failure in the Cardiac ICU During ECMO: A Case

Sonia Labarinas1, Kalpana Norbisrath1, Ibeh Nnaemeka2

  • 1Children's Heart Institute, Pediatric Cardiac Critical Care, Advanced Cardiopulmonary Therapies and Transplantation, University of Texas-Health Science Center at Houston, Houston, Texas, USA.

Journal of Clinical Apheresis
|October 5, 2025
PubMed

Insights

Therapeutic plasma exchange (TPE) may improve platelet counts in critically ill children with thrombocytopenia-associated multiple organ failure (TAMOF) on extracorporeal membrane oxygenation (ECMO). This study found TPE reduced organ severity scores but noted a high mortality rate.

Area of Science:

  • Pediatric Critical Care Medicine
  • Cardiovascular Surgery
  • Hematology

Background:

  • Extracorporeal membrane oxygenation (ECMO) is a life-support measure for pediatric cardio-respiratory failure.
  • Thrombocytopenia-associated multiple organ failure (TAMOF) is a severe complication in children on ECMO.
  • Therapeutic plasma exchange (TPE) is a potential treatment for TAMOF.

Purpose of the Study:

  • To describe the use and outcomes of TPE in critically ill children with TAMOF undergoing ECMO.
  • To evaluate the impact of TPE on platelet counts and organ severity scores in this patient population.

Main Methods:

  • A single-center retrospective case series of seven pediatric patients with congenital cardiac disease on ECMO and diagnosed with TAMOF.
  • Patients received TPE using a centrifugation-based apheresis instrument with bivalirudin for anticoagulation.
  • Data collected included patient demographics, ECMO characteristics, TPE details, platelet counts, and organ severity scores.

Main Results:

  • Seven patients underwent 30 TPE sessions; median sessions per patient was 3.
  • Median platelet count increased significantly post-TPE (45 to 64 × 10^9/L, p < 0.001) without transfusions.
  • Modified organ severity index decreased significantly (13 to 12, p < 0.001).
  • The overall mortality rate was 71%.

Conclusions:

  • Therapeutic plasma exchange may be effective in improving platelet counts in pediatric TAMOF patients on ECMO.
  • TPE demonstrated a reduction in organ severity scores in this cohort.
  • Despite potential benefits, the high mortality rate highlights the severity of TAMOF in ECMO patients.

Keywords:
childcritical illnessextracorporeal membrane oxygenationmultiple organ failureplasma exchangeplatelet countthrombocytopenia

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