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Therapeutic Plasma Exchange in Pediatric Care: Insights from a Tertiary Care Centre Experience

Sphurti Chowdhary1, Krishna Mohan Gulla1, Satya Prakash2

  • 1Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.

Indian Pediatrics
|November 24, 2025
PubMed

Insights

Therapeutic plasma exchange (TPE) is safe and effective for pediatric renal and non-renal conditions, including hemolytic uremic syndrome and autoimmune encephalitis. However, outcomes are impacted by delayed presentation and limited transplant options.

Area of Science:

  • Pediatric Nephrology
  • Pediatric Neurology
  • Pediatric Critical Care

Background:

  • Therapeutic plasma exchange (TPE) is an extracorporeal procedure used for various pediatric conditions.
  • Assessing TPE's safety, efficacy, and outcomes in children is crucial for optimizing treatment strategies.
  • Tertiary care centers play a vital role in managing complex pediatric cases requiring advanced therapies like TPE.

Purpose of the Study:

  • To evaluate the safety, efficacy, and clinical outcomes of therapeutic plasma exchange (TPE) in pediatric patients.
  • To identify patient subgroups that benefit most from TPE and factors influencing outcomes.
  • To analyze the spectrum of indications for TPE in a tertiary care setting.

Main Methods:

  • Retrospective analysis of pediatric patients who underwent TPE between January 2020 and July 2024.
  • Data collection from hospital records at a tertiary care hospital in Eastern India.
  • Analysis of indications, TPE cycles, patient demographics, and outcomes.

Main Results:

  • Forty children underwent 184 TPE cycles; common indications included liver disease (35%), renal diseases (27.5%), and secondary hemophagocytic lymphohistiocytosis (22.5%).
  • Excellent outcomes were observed in autoimmune encephalitis and ASFA category I renal diseases.
  • High mortality was linked to delayed presentation, organ failure, and lack of liver transplant facilities.

Conclusions:

  • Therapeutic plasma exchange (TPE) demonstrates effectiveness in treating pediatric hemolytic uremic syndrome and anti-N-methyl-D-aspartate receptor encephalitis.
  • TPE can be safely and effectively administered for both renal and non-renal indications in children.
  • Optimizing TPE protocols and timely intervention are essential for improving pediatric patient outcomes.
Abstract

Keywords:
American Society for ApheresisChildrenHUSPlasmapheresisTPE

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