Extracorporeal Photopheresis in Tandem With Continuous Renal Replacement Therapy: A Case Report

The use of therapeutic plasma exchange in tandem with continuous renal replacement therapy (CRRT) and extracorporeal membrane oxygenation (ECMO) has been well described; however, evidence showing the use of extracorporeal photopheresis (ECP) in tandem is lacking. Here we report a consult to perform ECP in tandem with CRRT for a 26-year-old female with a history of severe aplastic anemia who underwent allogeneic hematopoietic stem cell transplant, complicated by steroid-refractory acute graft-versus-host disease, vaso-occlusive disease, thrombotic microangiopathy, adenoviremia, and acute renal and respiratory failure. We performed six tandem ECP procedures (seven total) over 19 days, until the patient's decline resulted in compassionate discontinuation of care. During our procedures, CRRT managed the ionized calcium and adjusted the calcium infusion rate accordingly. We encountered red blood cell and optic bowl sensor alarms during ECP. This case, to our knowledge, is the first to describe the inpatient use of ECP in tandem with CRRT.