Therapeutic Plasma Exchange in Pediatric Patients: Results from a Single Center

Abstract

Therapeutic plasma exchange (TPE) can be applied as an effective therapeutic option in children with hematological, neurological, nephrological, and autoimmune/rheumatic disorders. We aimed to report our TPE experience in pediatric patients. In this article, we retrospectively reviewed the records of pediatric patients who underwent TPE between 2019 and 2021. A total of 128 TPE sessions were performed in 25 patients (13 males,12 females; mean age 59.6 ± 11.7 [3–198] months). The TPE indications were sepsis with/without multiorgan dysfunction syndrome in five patients, acute liver failure, hemolytic uremic syndrome caused by Shiga toxin, and autoimmune hemolytic anemia in three patients, respectively, multiple sclerosis, autoimmune encephalitis, and multisystem inflammatory syndrome in children (MIS-C) in two patients each, and myasthenia gravis crisis, meningococcemia, hemolytic uremic syndrome caused by coronavirus disease 2019, hemophagocytic lymphohistiocytosis, autoimmune encephalitis, and metabolic disease (fatty acid oxidation defect, liver failure) in one patient each. Based on our findings, we proposed that the American Society for Apheresis criteria should be updated according to newly described clinical conditions such as MIS-C.

Keywords

therapeutic plasma exchange - American Society for Apheresis guidelines - multisystem inflammatory syndrome in children

Authors' Contributions

T.D. and Y.K. contributed to analysis and drafted the manuscript. M.M., S.I., U.U.G., C.A., and C.D. helped evaluate subjects. Y.K. designed and critically revised the manuscript. All authors read and approved the manuscript.

Publikationsverlauf

Eingereicht: 17. September 2021

Angenommen: 08. Dezember 2021

Artikel online veröffentlicht:
03. Februar 2022

• References

• 1 Szczepiorkowski ZM, Winters JL, Bandarenko N. et al; Apheresis Applications Committee of the American Society for Apheresis. Guidelines on the use of therapeutic apheresis in clinical practice–evidence-based approach from the Apheresis Applications Committee of the American Society for Apheresis. J Clin Apher 2010; 25 (03) 83-177
• 2 McLeod BC. Therapeutic apheresis: history, clinical application, and lingering uncertainties. Transfusion 2010; 50 (07) 1413-1426
• 3 Reeves HM, Winters JL. The mechanisms of action of plasma exchange. Br J Haematol 2014; 164 (03) 342-351
• 4 Padmanabhan A, Connelly-Smith L, Aqui N. et al. Guidelines on the use of therapeutic apheresis in clinical practice - evidence-based approach from the Writing Committee of the American Society for Apheresis: The Eighth Special Issue. J Clin Apher 2019; 34 (03) 171-354
• 5 Schwartz J, Padmanabhan A, Aqui N. et al. Guidelines on the use of therapeutic apheresis in clinical practice-evidence-based approach from the Writing Committee of the American Society for Apheresis: the seventh special issue. J Clin Apher 2016; 31 (03) 149-162
• 6 Hunt EA, Jain NG, Somers MJ. Apheresis therapy in children: an overview of key technical aspects and a review of experience in pediatric renal disease. J Clin Apher 2013; 28 (01) 36-47
• 7 Haque A, Sher G, Hoda M, Moiz B. Feasibility of pediatric plasma apheresis in intensive care settings. Ther Apher Dial 2014; 18 (05) 497-501
• 8 Bhat CS, Gupta L, Balasubramanian S, Singh S, Ramanan AV. Hyperinflammatory syndrome in children associated with COVID-19: need for awareness. Indian Pediatr 2020; 57 (10) 929-935
• 9 De Palo T, Giordano M, Bellantuono R. et al. Therapeutic apheresis in children: experience in a pediatric dialysis center. Int J Artif Organs 2000; 23 (12) 834-839
• 10 Michon B, Moghrabi A, Winikoff R. et al. Complications of apheresis in children. Transfusion 2007; 47 (10) 1837-1842
• 11 Ilhan O, Uskent N, Arslan O. et al. National survey of hemapheresis practice in Turkey (1998). Transfus Sci 2000; 22 (03) 195-201
• 12 Sellier-Leclerc AL, Fremeaux-Bacchi V, Dragon-Durey MA. et al; French Society of Pediatric Nephrology. Differential impact of complement mutations on clinical characteristics in atypical hemolytic uremic syndrome. J Am Soc Nephrol 2007; 18 (08) 2392-2400
• 13 Caprioli J, Noris M, Brioschi S. et al; International Registry of Recurrent and Familial HUS/TTP. Genetics of HUS: the impact of MCP, CFH, and IF mutations on clinical presentation, response to treatment, and outcome. Blood 2006; 108 (04) 1267-1279
• 14 Watson RS, Crow SS, Hartman ME, Lacroix J, Odetola FO. Epidemiology and outcomes of pediatric multiple organ dysfunction syndrome. Pediatr Crit Care Med 2017; 18 (Suppl 1): S4-S16
• 15 Nguyen TC, Han YY, Kiss JE. et al. Intensive plasma exchange increases a disintegrin and metalloprotease with thrombospondin motifs-13 activity and reverses organ dysfunction in children with thrombocytopenia-associated multiple organ failure. Crit Care Med 2008; 36 (10) 2878-2887
• 16 Rimmer E, Houston BL, Kumar A. et al. The efficacy and safety of plasma exchange in patients with sepsis and septic shock: a systematic review and meta-analysis. Crit Care 2014; 18 (06) 699
• 17 Busund R, Koukline V, Utrobin U, Nedashkovsky E. Plasmapheresis in severe sepsis and septic shock: a prospective, randomised, controlled trial. Intensive Care Med 2002; 28 (10) 1434-1439
• 18 Knaup H, Stahl K, Schmidt BMW. et al. Early therapeutic plasma exchange in septic shock: a prospective open-label nonrandomized pilot study focusing on safety, hemodynamics, vascular barrier function, and biologic markers. Crit Care 2018; 22 (01) 285
• 19 Zanella A, Barcellini W. Treatment of autoimmune hemolytic anemias. Haematologica 2014; 99 (10) 1547-1554
• 20 Gordjani N, Kretschmer V, Töllner U, Rieger C. Fulminant autoimmune cold-type hemolysis with marked elevation of monothermic cold agglutinins. Successful therapy with membrane plasmapheresis [in German]. Monatsschr Kinderheilkd 1990; 138 (08) 454-456
• 21 Aladjidi N, Leverger G, Leblanc T. et al; Centre de Référence National des Cytopénies Auto-immunes de l'Enfant (CEREVANCE). New insights into childhood autoimmune hemolytic anemia: a French national observational study of 265 children. Haematologica 2011; 96 (05) 655-663
• 22 Barcellini W. Current treatment strategies in autoimmune hemolytic disorders. Expert Rev Hematol 2015; 8 (05) 681-691
• 23 Verdoni L, Mazza A, Gervasoni A. et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. Lancet 2020; 395 (10239): 1771-1778
• 24 Cheung EW, Zachariah P, Gorelik M. et al. Multisystem inflammatory syndrome related to COVID-19 in previously healthy children and adolescents in New York City. JAMA 2020; 324 (03) 294-296
• 25 Emeksiz S, Özcan S, Perk O. et al. Therapeutic plasma exchange: A potential management strategy for critically ill MIS-C patients in the pediatric intensive care unit. Transfus Apheresis Sci 2021; 60 (03) 103119
• 26 Keith P, Day M, Perkins L, Moyer L, Hewitt K, Wells A. A novel treatment approach to the novel coronavirus: an argument for the use of therapeutic plasma exchange for fulminant COVID-19. Crit Care 2020; 24 (01) 128
• 27 Churchwell KB, McManus ML, Kent P. et al. Intensive blood and plasma exchange for treatment of coagulopathy in meningococcemia. J Clin Apher 1995; 10 (04) 171-177
• 28 Ide K, Muguruma T, Shinohara M. et al. Continuous veno-venous hemodiafiltration and plasma exchange in infantile acute liver failure. Pediatr Crit Care Med 2015; 16 (08) e268-e274
• 29 Novelli G, Rossi M, Morabito V. et al. Pediatric acute liver failure with molecular adsorbent recirculating system treatment. Transplant Proc 2008; 40 (06) 1921-1924
• 30 Nadalin S, Heuer M, Wallot M. et al. Paediatric acute liver failure and transplantation: the University of Essen experience. Transpl Int 2007; 20 (06) 519-527