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VOLUME 27 , ISSUE 10 ( October, 2023 ) > List of Articles

BRIEF RESEARCH COMMUNICATION

Scope, Safety, and Feasibility of Therapeutic Plasma Exchange in Pediatric Intensive Care Unit: A Single-center Experience

Karthik Kumar Balasubramanian, Priyavarthini Venkatachalapathy, Saravanan Margabandhu, Rajeshwari Natraj, Vasanth Kumar Sridaran, Chidhambharam Lakshmanan

Keywords : Acute liver failure, American society for apheresis, Paediatric Intensive care, Plasmapheresis, Therapeutic plasma exchange, Thrombotic microangiopathy

Citation Information : Balasubramanian KK, Venkatachalapathy P, Margabandhu S, Natraj R, Sridaran VK, Lakshmanan C. Scope, Safety, and Feasibility of Therapeutic Plasma Exchange in Pediatric Intensive Care Unit: A Single-center Experience. Indian J Crit Care Med 2023; 27 (10):766-770.

DOI: 10.5005/jp-journals-10071-24541

License: CC BY-NC 4.0

Published Online: 29-09-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Abstract

Background: Indications for therapeutic plasma exchange (TPE) in the pediatric intensive care unit (PICU) are expanding. We aimed to study the demographics, clinical indications, and outcomes of patients who have undergone TPE in our PICU. Materials and methods: This is a retrospective study performed among children aged from 1 month to 16 years of age. Demographics, indications, therapeutic response, serious adverse events (SAE), PICU length of stay (LOS), and death during hospitalization were studied as outcome variables. Results: Therapeutic plasma exchange was performed in 115 sessions on 24 patients for 12 different indications falling under various American Society for Apheresis (ASFA) categories. Therapeutic plasma exchange was performed on ten, four, and ten children for ASFA category I, II, and III indications, respectively. The most common indications were thrombotic microangiopathy (TMA) (8/24) and acute liver failure (ALF) (6/24). During those 115 sessions, a total of five serious adverse events (SAEs) occurred, accounting for 4.3% of the cases. Minor adverse events occurred in 12 sessions (10.4%). Therapeutic response was good in 17 patients (71%) including 5 patients who underwent standard volume TPE (SV-TPE) for ALF. Median PICU LOS was 9 (range 2–120) days. The mortality rate was 12.5% (3/24). Conclusion: Therapeutic plasma exchange is effective in various clinical conditions involving various organ systems. It is an excellent therapeutic modality in children with ALF, irrespective of the exchange volume and TMA. However, SAEs do occur in the minority.

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  1. Lehmann HC, Hartung HP, Hetzel GR, Stüve O, Kieseier BC. Plasma exchange in neuroimmunological disorders: Part 1: Rationale and treatment of inflammatory central nervous system disorders. Arch Neurol 2006;63(7):930–935. DOI: 10.1001/archneur.63.7.930.
  2. Connelly-Smith L, Alquist CR, Aqui NA, Hofmann JC, Klingel R, Onwuemene OA, 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 Ninth Special Issue. J Clin Apher 2023;38(2):77–278. DOI: 10.1002/jca.22043.
  3. Alexander EC, Deep A. Therapeutic plasma exchange in children with acute liver failure (ALF): Is it time for incorporation into the ALF armamentarium? Pediatr Nephrol 2021;1:3. DOI:10.1007/s00467-021-05289-0.
  4. Cortina G, Ojinaga V, Giner T, Riedl M, Waldegger S, Rosales A, et al. Therapeutic plasma exchange in children: One center's experience. J Clin Apher 2017;32(6):494–500. DOI: 10.1002/jca.21547.
  5. Cortina G, McRae R, Chiletti R, Butt W. Therapeutic plasma exchange in critically ill children requiring intensive care. Pediatr Crit Care Med 2018;19(2):e97–e104. DOI: 10.1097/PCC.0000000000001400.
  6. Keskin H, Paksu MŞ, Yener N, Temel Köksoy Ö, Kartal İ, Albayrak C, et al. Plasma exchange in critically ill children: A single-center experience. J Pediatr Emerg Intensive Care Med 2018;5(1):10–14. DOI: 10.4274/cayd.28199.
  7. Haque A, Sher G, Hoda M, Moiz B. Feasibility of pediatric plasma apheresis in intensive care settings. Ther Apher Dial 2014;18(5):497–501. DOI: 10.1111/1744-9987.12173.
  8. Padmanabhan A, Connelly-Smith L, Aqui N, Balogun RA, Klingel R, Meyer E, 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(3):171–354. DOI: 10.1002/jca.21705.
  9. Weiss PF, Klink AJ, Friedman DF, Feudtner C. Pediatric therapeutic plasma exchange indications and patterns of use in us children's hospitals. J Clin Apher 2012;27(6):287–294. DOI: 10.1002/jca.21242.
  10. Hans R, Tiewsoh K, Lamba DS, Dawman L, Prakash S, Tripathi PP, et al. Centrifugal therapeutic plasma exchange in pediatric patients. Indian J Pediatr 2021;88(8):757–763. DOI: 10.1007/s12098-020-03657-6.
  11. Duyu M, Turkozkan C. Therapeutic plasma exchange in the pediatric intensive care unit: A single-center 5-Year experience. Transfus Apher Sci 2020;59(5):102959. DOI: 10.1016/j.transci.2020.102959.
  12. Sık G, Demirbuga A, Annayev A, Akcay A, Çıtak A, Öztürk G. Therapeutic plasma exchange in pediatric intensive care: Indications, results and complications. Ther Apher Dial 2020;24(2):221–229. DOI: 10.1111/1744-9987.13474.
  13. Margabandhu S, Ranjit S, Jayakumar I, Sundaramoorthy C, Janarthanan M, Reddy J, et al. Therapeutic plasma exchange for pediatric nonrenal disease indications and outcomes: A single-center experience. Asian J Transfus Sci 2018;12(2):127–135. DOI: 10.4103/ajts.AJTS_123_17.
  14. Hans R, Sharma RR, Marwaha N, Suri D, Kumar R, Gupta A, et al. Efficacy and safety of therapeutic plasma exchange by using apheresis devices in pediatric atypical hemolytic uremic syndrome patients. J Clin Apher 2016;31(4):381–387. DOI: 10.1002/jca.21412.
  15. Mazahir R, Anand K, Pruthi PK. Therapeutic plasma exchange in children - Experience from a tertiary care center. Indian Pediatr 2021;58(12):1151–1154. PMID: 34183464.
  16. Misanovic V, Pokrajac D, Zubcevic S, Hadzimuratovic A, Rahmanovic S, Dizdar S, et al. Plasmapheresis in Pediatric Intensive Care Unit. Med Arch 2016;70(5):332–335. DOI: 10.5455/medarh.2016.70.332-335.
  17. Reddy SK, Jahan A, Chaturvedi S, Agarwal I. Plasma exchange for paediatric kidney disease-indications and outcomes: a single-centre experience. Clin Kidney J 2015;8(6):702–707. DOI: 10.1093/ckj/sfv084.
  18. Norda R, Stegmayr BG, Berlin G, Kurkus J, Jonsson S, Söderström T, et al. Therapeutic apheresis in Sweden: Update of epidemiology and adverse events. Transfus Apher Sci 2003;29(2):159–166. DOI: 10.1016/S1473-0502(03)00121-6.
  19. Stegmayr B, Ptak J, Wikström B. World apheresis registry report. Transfus Apher Sci 2007;36(1):13–16. DOI: 10.1016/j.transci.2006.06.009.
  20. Witt V, Stegmayr B, Ptak J, Wikström B, Berlin G, Axelsson CG, et al. World apheresis registry data from 2003 to 2007, the pediatric and adolescent side of the registry. Transfus Apher Sci 2008;39(3):255–260. DOI: 10.1016/j.transci.2008.09.001.
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