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Intensive blood and plasma exchange for treatment of coagulopathy in meningococcemia

K B Churchwell1, M L McManus, P Kent

  • 1Multidisciplinary intensive Care Unit, Children's Hospital, Boston, Massachusetts 02115, USA.

Journal of Clinical Apheresis
|January 1, 1995
PubMed

Insights

Intensive plasma exchange (IPE) or whole blood exchange (WBE) effectively treated coagulopathy in critically ill children with meningococcemia. This procedure improved coagulation markers and survival rates without causing fluid overload.

Area of Science:

  • Pediatric Critical Care Medicine
  • Hematology
  • Infectious Diseases

Background:

  • Fulminant meningococcemia presents with purpura and disseminated intravascular coagulation (DIC), often leading to poor prognoses.
  • Standard medical therapy may be insufficient for critically ill pediatric patients with severe coagulopathy.

Purpose of the Study:

  • To evaluate the safety and efficacy of intensive plasma exchange (IPE) or whole blood exchange (WBE) in pediatric patients with fulminant meningococcemia and DIC.
  • To assess the impact of IPE/WBE on coagulation parameters and patient outcomes.

Main Methods:

  • Eight pediatric patients with fulminant meningococcemia, purpura, and DIC received IPE/WBE in addition to standard therapy.
  • IPE/WBE utilized fresh frozen plasma and cryoprecipitate as replacement solutions, performed with a continuous flow system.
  • Coagulation parameters (fibrinogen, PT, APTT) and fluid balance were monitored.

Main Results:

  • IPE/WBE rapidly improved coagulation parameters: fibrinogen increased, PT and APTT decreased significantly.
  • Seven of eight patients (87.5%) survived the initial presentation; the only early death was due to meningitis with cerebral edema.
  • The procedure was safe, with no significant bleeding or cardiovascular complications, and no evidence of fluid overload.

Conclusions:

  • IPE/WBE is a safe and effective therapeutic option for critically ill pediatric patients with meningococcemia-induced coagulopathy.
  • This exchange therapy can rapidly correct coagulopathy without inducing fluid overload, improving survival in high-risk patients.

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