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Wildes DM, Devlin C, Costigan CS, Raftery T, Hensey C, Waldron M, Dolan N, Riordan M, Sweeney C, Stack M, Cotter M, Lynch B, Gorman KM, Awan A. Therapeutic plasma exchange in paediatric nephrology in Ireland. Ir J Med Sci 2024; 193:1589-1594. [PMID: 37940814 DOI: 10.1007/s11845-023-03560-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/30/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Therapeutic plasma exchange (TPE) is utilised in the management of a limited number of paediatric renal conditions. Despite its widespread acceptance and advancements in the practice of apheresis, there remains a paucity of data pertaining to paediatrics. We present a large retrospective review of our cohort of paediatric patients undergoing TPE for renal indications, outlining their outcomes and complications. METHODS A retrospective chart review was conducted for all patients (under 16 years) undergoing TPE for renal conditions between January 2002 and June 2019 in Ireland. Demographic and clinical data were extracted, with patients anonymised and stratified according to their pathology. RESULTS A total of 58 patients were identified. A total of 1137 exchanges were performed using heparin sodium anticoagulation. The median age was 35.5 months (IQR 18-110 months). The leading indication was neurological involvement in Shiga toxin-producing Escherichia coli haemolytic uraemic syndrome (STEC-HUS) (n = 29). Complications (minor or major) occurred in 65.5% (n = 38) of patients, with most experiencing minor complications 58.6% (n = 34). Asymptomatic hypocalcaemia was the most common complication in 43.1% (n = 25). CONCLUSIONS Our experience of TPE, spanning 1137 exchanges, proved a safe, well-tolerated therapy. Most complications were minor, and with therapy conducted in specialised centres, there are very low levels of adverse events.
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Affiliation(s)
- Dermot M Wildes
- The Department for Paediatric Nephrology & Transplantation, Children's Health Ireland, Dublin, Ireland.
| | - Conor Devlin
- The Department for Paediatric Nephrology & Transplantation, Children's Health Ireland, Dublin, Ireland
| | - Caoimhe Suzanne Costigan
- The Department for Paediatric Nephrology & Transplantation, Children's Health Ireland, Dublin, Ireland
| | - Tara Raftery
- The Department for Paediatric Nephrology & Transplantation, Children's Health Ireland, Dublin, Ireland
| | - Conor Hensey
- The Department of General Paediatrics, Children's Health Ireland, Dublin, Ireland
| | - Mary Waldron
- The Department for Paediatric Nephrology & Transplantation, Children's Health Ireland, Dublin, Ireland
| | - Niamh Dolan
- The Department for Paediatric Nephrology & Transplantation, Children's Health Ireland, Dublin, Ireland
| | - Michael Riordan
- The Department for Paediatric Nephrology & Transplantation, Children's Health Ireland, Dublin, Ireland
- The Department of Paediatrics, Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin 2, Ireland
| | - Clodagh Sweeney
- The Department for Paediatric Nephrology & Transplantation, Children's Health Ireland, Dublin, Ireland
| | - Maria Stack
- The Department for Paediatric Nephrology & Transplantation, Children's Health Ireland, Dublin, Ireland
| | - Melanie Cotter
- The Department of Haematology, Children's Health Ireland, Dublin, Ireland
| | - Bryan Lynch
- The Department of Neurology & Clinical Neurophysiology, Children's Health Ireland, Dublin, Ireland
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Kathleen Mary Gorman
- The Department of Neurology & Clinical Neurophysiology, Children's Health Ireland, Dublin, Ireland
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Atif Awan
- The Department for Paediatric Nephrology & Transplantation, Children's Health Ireland, Dublin, Ireland
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
- The Department of Paediatrics, Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin 2, Ireland
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Balasubramanian KK, Venkatachalapathy P, Margabandhu S, Natraj R, Sridaran VK, Lakshmanan C, Ranjit S. Scope, Safety, and Feasibility of Therapeutic Plasma Exchange in Pediatric Intensive Care Unit: A Single-center Experience. Indian J Crit Care Med 2023; 27:766-770. [PMID: 37908426 PMCID: PMC10613876 DOI: 10.5005/jp-journals-10071-24541] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/25/2023] [Indexed: 11/02/2023] Open
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. How to cite this article Balasubramanian KK, Venkatachalapathy P, Margabandhu S, Natraj R, Sridaran VK, Lakshmanan C, et al. 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.
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Affiliation(s)
| | | | | | - Rajeshwari Natraj
- Department of Paediatric Intensive Care Unit, Apollo Cradle & Children's Hospital, Chennai, Tamil Nadu, India
| | - Vasanth Kumar Sridaran
- Department of Paediatric Intensive Care Unit, Apollo Cradle & Children's Hospital, Chennai, Tamil Nadu, India
| | - Chidhambharam Lakshmanan
- Department of Paediatric Intensive Care Unit, Apollo Cradle & Children's Hospital, Chennai, Tamil Nadu, India
| | - Suchitra Ranjit
- Department of Paediatric Intensive Care Unit, Apollo Cradle & Children's Hospital, Chennai, Tamil Nadu, India
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Tiwari AK, Setya D, Tanna D, Arora D, Aggarwal G, Gupta R, Bansal SB, Sethi SK. Patient outcome in antibody-positive systemic vasculitis treated with therapeutic plasma exchange. Asian J Transfus Sci 2023; 17:79-84. [PMID: 37188030 PMCID: PMC10180801 DOI: 10.4103/ajts.ajts_50_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/29/2022] [Accepted: 05/29/2022] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Therapeutic plasma exchange (TPE) has been advocated as an adjunct to steroids and cytotoxic drugs in treating patients suffering from vasculitis and presenting with active disease, but we still have insufficient evidence on its effectiveness in improving the clinical response, especially in India. This study was planned to study the clinical outcome in severe vasculitic presentations treated with TPE as an adjunctive therapy. MATERIALS AND METHODS A retrospective analysis of TPE procedures performed from July 2013 to July 2017 in the department of transfusion medicine at a large tertiary care hospital was done. All consecutive patients admitted with new diagnosis of systemic vasculitis presenting with active disease and severe presentations such as advanced renal failure or severe respiratory abnormalities or life-threatening vasculitis affecting the gastrointestinal tract, neurological and musculoskeletal system; who needed TPE for removal of preformed antibodies, were included in the study. RESULTS There were a total of 31 patients in whom TPE was performed for severe systemic vasculitis; 26 adults and five pediatric. Six patients tested positive for perinuclear fluorescence, 13 for cytoplasmic fluorescence (cANCA), two for atypical antineutrophil cytoplasmic autoantibody, seven for anti-glomerular basement membrane antibodies, two for antinuclear antibodies (ANA), and one patient tested positive for ANA as well as cANCA before the augmentation of TPE. Out of 31, seven patients showed no clinical improvement and succumbed to the disease. At the end of desired number of procedures, 19 tested negative and five tested weak positive for their respective antibodies. CONCLUSION Favorable clinical outcomes were observed with TPE in patients with antibody-positive systemic vasculitis.
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Affiliation(s)
- Aseem Kumar Tiwari
- Department of Transfusion Medicine, Medanta – The Medicity, Gurgaon, Haryana, India
| | - Divya Setya
- Department of Transfusion Medicine, Medanta – The Medicity, Gurgaon, Haryana, India
| | - Dhaval Tanna
- Department of Rheumatology and Clinical Immunology, Medanta – The Medicity, Gurgaon, Haryana, India
| | - Dinesh Arora
- Department of Transfusion Medicine, Medanta – The Medicity, Gurgaon, Haryana, India
| | - Geet Aggarwal
- Department of Transfusion Medicine, Medanta – The Medicity, Gurgaon, Haryana, India
| | - Rajiva Gupta
- Department of Rheumatology and Clinical Immunology, Medanta – The Medicity, Gurgaon, Haryana, India
| | - Shyam Bihari Bansal
- Department of Nephrology, Kidney and Urology Institute, Medanta – The Medicity, Gurgaon, Haryana, India
| | - Sidharth Kumar Sethi
- Department of Nephrology, Kidney and Urology Institute, Medanta – The Medicity, Gurgaon, Haryana, India
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Webb TN, Bell J, Griffin R, Dill L, Gurosky C, Askenazi D. Retrospective analysis comparing complication rates of centrifuge vs membrane-based therapeutic plasma exchange in the pediatric population. J Clin Apher 2022; 37:263-272. [PMID: 35137962 DOI: 10.1002/jca.21969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 01/13/2022] [Accepted: 01/22/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND There are two conventional modalities used to perform therapeutic plasma exchange (TPE): centrifuge TPE (cTPE) or membrane TPE (mTPE). There is limited data on complications with mTPE. OBJECTIVE We sought to better understand the patient and machine complications of mTPE compared to cTPE. We hypothesize that our protocol for mTPE using heparin anticoagulation is well-tolerated. METHODS In this retrospective cohort study of children <21 years of age, we evaluated differences in patient and machine characteristics and complications between cTPE (with citrate anticoagulation) vs mTPE (with heparin anticoagulation). RESULTS Of the 105 patients who met inclusion/exclusion criteria, 63 received cTPE and 42 mTPE via Prismaflex. Those who used mTPE were younger (4.8 ± 2.8 years vs 15.2 ± 3.7 years, P = .0001) and weighed less (19.5 ± 10.6 vs 71.7 ± 28.5 kg, P = .0001). There were no significant differences in patient-related complications or indications for TPE between the two modalities. Of the 1031 therapies performed,1003 therapies were analyzed (646 using cTPE and 357 using mTPE) due to exclusion criteria. No significant difference in patient complications were detected between groups. Machine-related complications were infrequent in both approaches. More circuits clotted during mTPE than during cTPE (6.7% [24/357] vs 0% [0/646]; P < 0.001). CONCLUSION Although we use mTPE in smaller children, we showed low rates of complications that were not statistically different from cTPE performed in older children. While the overall rate of circuit clotting using mTPE was low, it occurred more commonly than with cTPE.
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Affiliation(s)
- Tennille N Webb
- Pediatrics/Pediatric Nephrology, University of Alabama at Birmingham/Children's of Alabama, Birmingham, Alabama, USA
| | - Jeremiah Bell
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Russell Griffin
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lynn Dill
- Pediatrics/Pediatric Nephrology, University of Alabama at Birmingham/Children's of Alabama, Birmingham, Alabama, USA
| | - Catherine Gurosky
- Pediatrics/Pediatric Nephrology, University of Alabama at Birmingham/Children's of Alabama, Birmingham, Alabama, USA
| | - David Askenazi
- Pediatrics/Pediatric Nephrology, University of Alabama at Birmingham/Children's of Alabama, Birmingham, Alabama, USA
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Keklik M, Çelik S, Yıldızhan E. Comparison of centrifugal and membrane filtration modalities on therapeutic plasma exchange. J Clin Apher 2022; 37:217-222. [PMID: 34978347 DOI: 10.1002/jca.21961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/21/2021] [Accepted: 12/21/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Therapeutic plasma exchange (TPE) is a technique in which plasma is separated from the rest of the blood in an extracorporeal system and exchanged with appropriate fluids. Two main methods are used in the TPE process: membrane filtration (mTPE) and centrifuge-based (cTPE) TPE. We aimed to compare the efficacy of these methods and their effects on hemostatic parameters. METHODS A total of 88 TPE procedures performed on 51 patients were evaluated retrospectively. Hemostatic parameters, such as pre- and postoperative complete blood count, fibrinogen, and D-dimer levels were evaluated, as well as data recorded during the TPE application, such as preparation time, operation time, and plasma removal efficiency (PRE). The Fresenius multiFiltrate, software version 5.3 device was used for the mTPE procedure and the Spectra Optia device was used for cTPE. RESULTS While both modalities removed similar amounts of plasma, the total time to perform the cTPE treatment was significantly lower than the mTPE (107 [66-191] min vs 116.5 [80-181] min, respectively) (P = .026). At the PRE rate, the mTPE procedure was as effective as cTPE (86.8% ± 16.3 vs 85.15% ± 17.63 respectively, P = .64). The difference was not statistically significant, and this is the highest rate of PRE reported about the mTPE procedure in the literature. CONCLUSIONS To our knowledge, this is the first study directly comparing Fresenius and Spectra regarding mTPE and cTPE. While there were no statistically significant differences regarding PRE, treatment time of the mTPE was significantly longer than the cTPE treatment time.
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Affiliation(s)
- Muzaffer Keklik
- Department of Hematology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Serhat Çelik
- Department of Hematology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Esra Yıldızhan
- Department of Hematology, Kayseri City Hospital, Kayseri, Turkey
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Hans R, Tiewsoh K, Lamba DS, Dawman L, Prakash S, Tripathi PP, Sankhyan N, Sharma RR, Marwaha N. Centrifugal Therapeutic Plasma Exchange in Pediatric Patients. Indian J Pediatr 2021; 88:757-763. [PMID: 33527338 DOI: 10.1007/s12098-020-03657-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 12/31/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To assess the safety of centrifugal therapeutic plasma exchange (TPE) in pediatric patients. METHODS The authors did a retrospective analysis of all TPE procedures performed in pediatric patients over a period of 19 y (2001-2019). Procedures were done on different apheretic devices, daily or on alternate days depending on the clinical condition of the patient. Adverse events during the procedure were noted and analyzed. RESULTS A total of 672 TPE (with mean of 6.77 ± 4.85) procedures were performed for 99 pediatric patients with different indications like hematological (n = 68), renal (n = 12), neurology (n = 18) and hepatology (n = 1). The mean age was 7.00 ± 3.11 y and weight was 20.72 ± 9.17 kg. Adverse events (AEs) were observed during 34 (5%) procedures, most common were allergic reactions to replacement fluid (2.24%) followed by hypotension (1.04%), symptomatic hypocalcemia (1.04%), line occlusion (0.59%), and febrile non hemolytic transfusion reaction (0.41%). A significant correlation of AEs was observed with weight (p = 0.045), total blood volume of the patient (p = 0.04), increasing number of procedures (p = 0.000) and replacement fluid [Fresh frozen plasma (FFP)] (p = 0.04). All AEs were managed as per departmental standard operating procedures (SOPs) completing procedures successfully except one which was abandoned. No mortality was observed during the procedures. CONCLUSION TPE is a safe therapeutic modality in pediatric patients when performed under expert technical supervision with proper SOPs in place.
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Affiliation(s)
- Rekha Hans
- Department of Transfusion Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Karalanglin Tiewsoh
- Department of Pediatric Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Divjot Singh Lamba
- Department of Transfusion Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Lesa Dawman
- Department of Pediatric Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Satya Prakash
- Department of Transfusion Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Parmatma Prasad Tripathi
- Department of Transfusion Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Naveen Sankhyan
- Department of Pediatric Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ratti Ram Sharma
- Department of Transfusion Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Neelam Marwaha
- Department of Transfusion Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Mazahir R, Anand K, Pruthi PK. Therapeutic Plasma Exchange in Children — Experience From a Tertiary Care Center. Indian Pediatr 2021. [DOI: 10.1007/s13312-021-2398-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Therapeutic plasma exchange: single-center experience in children with kidney disorders. Pediatr Nephrol 2021; 36:621-629. [PMID: 32949283 DOI: 10.1007/s00467-020-04744-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 07/31/2020] [Accepted: 08/25/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Therapeutic plasma exchange (TPE) is used in kidney diseases as an adjunct treatment. Little has been described as to its effectiveness in kidney disorders in children. This study aimed to assess the safety, efficacy, and outcomes of patients who underwent TPE for kidney indications. METHODS Retrospective chart review of patients receiving TPE from 2010 to 2018 for kidney indications, such as antibody-mediated rejection, bone marrow transplant-associated thrombotic microangiopathy (TA-TMA), atypical hemolytic uremic syndrome, transplant recurrence of focal segmental glomerulosclerosis, and glomerulonephritis. Outcomes assessed were trends in kidney function, mortality, and progression to stage 5 chronic kidney disease (CKD 5). Significant hypocalcemia was defined as ionized calcium < 1 mmol/L. RESULTS A total of 641 TPE procedures were performed on 47 patients (25 male). Average age was 12.8 ± 5.9 years. Median glomerular filtration rate (GFR) improved from baseline to end of TPE treatments (pre 44.9 (19.8, 79), end 56.1 (23, 98) [p = 0.02]). Ten out of 47 children developed CKD 5. Seven out of 47 patients died; 5 had TA-TMA. Initial 7 consecutive sessions were reviewed for complications. Among 335 procedures, 41 episodes of significant hypocalcemia were noted (12.2%); only 1 was symptomatic. Of the 26 episodes (7.7%) of allergic reactions, all were associated with the use of FFP; 5 were anaphylactic. No TPE-associated mortality was noted. CONCLUSIONS TPE is a relatively well-tolerated useful adjunct therapy in children with kidney indications. The benefit of TPE has to be balanced with risks such as hypocalcemia and allergic reactions which can occur more frequently with FFP. Graphical abstract.
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Abstract
Therapeutic plasma exchange is a blood purification technique designed for the removal of large molecular weight toxins such as pathogenic antibodies and lipoproteins. Plasma exchange can be performed either by membrane separation or centrifugation. Centrifugal plasma exchange is more common in the United States, while membrane separation is more popular in Germany and Japan. The membrane separation technique is similar to the ultrafiltration procedures performed with a standard dialysis machine but in which the membrane's pores are large enough to allow removal of all circulating molecules while retaining the cellular components. The current availability of plasma separation membranes compatible with CRRT systems has dramatically increased the potential for almost all nephrologists to perform these treatments. This review describes the membrane separation techniques available in the United States, the practical aspects of ordering and operating a membrane separation plasma exchange procedure, and its possible complications.
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Affiliation(s)
- Sadiq Ahmed
- Division of Nephrology Bone and Mineral Metabolism, University of Kentucky, Lexington, Kentucky
| | - Andre Kaplan
- Division of Nephrology, University of Connecticut Health Center, Farmington, Connecticut
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Margabandhu S, Ranjit S, Jayakumar I, Sundaramoorthy C, Janarthanan M, Reddy J, Thiagarajan M, Jayamoorthy S, Vishwanathan L. Therapeutic plasma exchange for pediatric nonrenal disease indications and outcomes: A single-center experience. Asian J Transfus Sci 2018; 12:127-135. [PMID: 30692797 PMCID: PMC6327757 DOI: 10.4103/ajts.ajts_123_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Outcome data in pediatric plasma exchange, especially in nonrenal indications are scarce. We aimed to evaluate its role and outcome in our patients. SUBJECTS AND METHODS A retrospective study of children admitted in the year 2016 to the Pediatric Intensive Care Unit requiring plasma exchange for nonrenal indications was undertaken. Plasma exchange was given as adjunctive therapy along with primary treatment for the disease concerned. Demographic and clinical data were studied, and descriptive statistical analysis was carried out. RESULTS Ten children underwent plasma exchange during this 1-year period with a male: female ratio of 3:2 and a mean age of 10 years (range 3-16 years). The indications were acute disseminated encephalomyelitis (n = 2), acute neuromyelitis optica (n = 1), catastrophic antiphospholipid antibody syndrome secondary to systemic lupus erythematosus (SLE) (n = 1), severe SLE with cerebritis/hemophagocytic lymphohistiocytosis (HLH) (n = 2), severe dengue sepsis with HLH/multi-organ dysfunction syndrome (n = 2), and thrombotic microangiopathy secondary to snake bite envenomation (n = 2). All received either 1.5 or 2 times plasma volume exchange (mean sessions - 4, range = 1-6). The mean duration of stay in hospital was 17.2 days (range = 3-40 days), and follow-up was 78 days (range = 3-180 days), with the majority of children (8/10, 80%) survived from the catastrophic illness at the time of discharge. Two children (2/10, 20%) succumbed due to the disease per se in severe dengue sepsis in one and enterobacteriaceae sepsis (hospital-acquired pneumonia) in another. CONCLUSION Plasma exchange was found to be beneficial as complementary therapy in a critical care setting, especially for nonrenal indications.
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Affiliation(s)
| | - Suchitra Ranjit
- Department of Paediatric Intensive Care Unit, Apollo Children's Hospitals, Chennai, Tamil Nadu, India
| | - Indira Jayakumar
- Department of Paediatric Intensive Care Unit, Apollo Children's Hospitals, Chennai, Tamil Nadu, India
| | - Chitra Sundaramoorthy
- Department of Paediatric Rheumatology, Apollo Children's Hospitals, Chennai, Tamil Nadu, India
| | - Mahesh Janarthanan
- Department of Paediatric Rheumatology, Apollo Children's Hospitals, Chennai, Tamil Nadu, India
| | - Jayakumar Reddy
- Department of Paediatrics, Apollo Children's Hospitals, Chennai, Tamil Nadu, India
| | - Meena Thiagarajan
- Department of Paediatrics, Apollo Children's Hospitals, Chennai, Tamil Nadu, India
| | - Shyamala Jayamoorthy
- Department of Paediatrics, Apollo Children's Hospitals, Chennai, Tamil Nadu, India
| | - Latha Vishwanathan
- Department of Paediatrics, Apollo Children's Hospitals, Chennai, Tamil Nadu, India
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Tiwari AK, Bhardwaj G, Aggarwal G, Arora D, Dara RC, Acharya DP, Gayam S, Choudhuri J. Changing Trends in Therapeutic Plasmapheresis: An Indian Perspective. Ther Apher Dial 2017; 21:500-506. [DOI: 10.1111/1744-9987.12549] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 03/07/2017] [Accepted: 03/21/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Aseem K Tiwari
- Department of Transfusion Medicine; Medanta-The Medicity; Gurgaon India
| | - Gunjan Bhardwaj
- Department of Transfusion Medicine; Medanta-The Medicity; Gurgaon India
| | - Geet Aggarwal
- Department of Transfusion Medicine; Medanta-The Medicity; Gurgaon India
| | - Dinesh Arora
- Department of Transfusion Medicine; Medanta-The Medicity; Gurgaon India
| | - Ravi C Dara
- Department of Transfusion Medicine; Medanta-The Medicity; Gurgaon India
| | - Devi P Acharya
- Department of Transfusion Medicine; Medanta-The Medicity; Gurgaon India
| | - Sangeetha Gayam
- Department of Transfusion Medicine; Kamineni Institute of Medical Sciences; Hyderabad Narketpally India
| | - Jui Choudhuri
- Department of Transfusion Medicine; Medanta-The Medicity; Gurgaon India
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Sanchez-Niño MD, Ortiz A. Thrombotic microangiopathy: expanding genetic, clinical and therapeutic spectra and the need for worldwide implementation of recent advances. Clin Kidney J 2015; 8:686-9. [PMID: 26613024 PMCID: PMC4655809 DOI: 10.1093/ckj/sfv115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2015] [Indexed: 02/07/2023] Open
Abstract
In this issue of CKJ, four reports address different aspects of a rare condition, thrombotic microangiopathy, including atypical haemolytic uraemic syndrome. For rare diseases, a single case report may provide hypothesis-generating information that may lead to concept-changing research with the potential to influence patient care. The present reports and small series illustrate the following aspects of thrombotic microangiopathy: (i) the role of whole-exome sequencing and of repeating the family history assessment over time in reducing the number of chronic kidney disease patients with non-specific diagnosis (e.g. focal segmental glomerulosclerosis without any further indication as to aetiology or hypertension-attributed kidney disease) and the need for further studies on the potential for type IV collagen mutations to be associated with thrombotic microangiopathy, i.e. the potential for an expanding genetic spectrum; (ii) the expanding clinical spectrum from an acute catastrophic disease to a chronic, mild, stable condition with unknown long-term consequences and uncharted therapeutic approaches; (iii) the expanding therapeutic spectrum, with the successful use of eculizumab to treat thrombotic microangiopathy in the context of overlap autoimmune disease and (iv) the huge worldwide inequalities in the implementation of these and other advances. International collaboration is needed to address these issues and should encompass the wider use of already available registries for this rare disease and the worldwide implementation of current effective, yet expensive, therapies.
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Affiliation(s)
- Maria D Sanchez-Niño
- IIS-Fundacion Jimenez Diaz, School of Medicine, Universidad Autonoma de Madrid; Fundacion Renal Iñigo Alvarez de Toledo-IRSIN and REDINREN , Madrid , Spain
| | - Alberto Ortiz
- IIS-Fundacion Jimenez Diaz, School of Medicine, Universidad Autonoma de Madrid; Fundacion Renal Iñigo Alvarez de Toledo-IRSIN and REDINREN , Madrid , Spain
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