Pediatric Therapeutic Plasma Exchange: Characterization of Practice, Epidemiology, and Safety Profile at a Children's Hospital in the United States

There is a need to better understand the indications and safety profiles for therapeutic plasma exchange (TPE) in children. We aimed to assess pediatric TPE practice at a large academic center by retrospective chart review from 2011 to 2022. Patient demographics and clinical information including American Society for Apheresis (ASFA) category were analyzed. The cohort consisted of 438 patients, 52.1% female with a median age of 11.4 years, who underwent 3385 TPE procedures. The adverse reaction rate was 6.8%, with hypotension being most common. Tandem circuits were used in 3.9% of procedures, and the adverse reaction rate was significantly higher, 16.1% (p = < 0.05). Cryoprecipitate transfusion occurred in 29.0% of procedures for hypofibrinogenemia (median treatment number 3) and 19.1% of procedures required an RBC prime. Our findings highlight contemporary practical considerations for running a pediatric apheresis service, provide insight into managing tandem procedures, and may provide guidance for future research endeavors and clinical practice.