The hemostatic system in children undergoing intensive plasma exchange

Area of Science:

• Pediatric Hematology
• Hemostasis and Thrombosis
• Plasma Exchange Therapy

Background:

• Plasma exchange (PE) is used therapeutically, but its impact on the hemostatic system requires careful evaluation, especially in pediatric patients.
• Replacement fluids devoid of coagulation proteins are utilized in PE, necessitating an understanding of their effects on hemostasis.

Purpose of the Study:

• To investigate the effects of intensive plasma exchange therapy on the hemostatic system in children.
• To assess the potential for hemorrhagic or thrombotic complications during and after plasma exchange.

Main Methods:

• Five pediatric patients underwent ten intensive plasma exchange procedures using protein-free replacement fluids.
• Coagulation factors, antithrombin III, and plasminogen levels were measured immediately post-procedure and at 24 hours.

Main Results:

• No hemorrhagic episodes were directly linked to plasma exchange; however, one patient experienced recurrent vascular access thrombosis.
• Significant decreases (35-67%) in coagulation factors (II-XII), antithrombin III (58-60%), and plasminogen (66%) were observed immediately after plasmapheresis.
• All measured hemostatic factors returned to normal levels within 24 hours post-procedure.

Conclusions:

• Intensive plasma exchange, despite depleting coagulation factors, may increase thrombosis risk, particularly indicated by decreased antithrombin III and plasminogen.
• The findings suggest a need for vigilance regarding thrombotic events in patients undergoing intensive PE.
• Children exhibit robust synthetic capabilities, rapidly replenishing hemostatic factors post-plasma exchange.