Combined Plasma Exchange and Immunoglobulin Therapy in a Case of Severe Childhood Guillain-Barré Syndorome

Abstract

Plasma exchange (PE) was performed three times within seven days from the onset of symptoms (total exchanged plasma volume; 180ml·kg-1) in a two-year old female child with severe Guillain-Barre syndrome who required mechanical ventilation.This was followed by Immunoglobulin therapy (0.4g·kg-1·day-1) for 5 days. The patieat was weaned from mechanical ventilation on the 34th day in the ICU.Centrifugal PE with a larger circuit volume was complicated by hemodilution, while ultrafiltration PE was complicated by intra-circuit hemolysis. Although the hemodynamics remained stable and no obvious electrolyte abnormalities were observed in this patient, changes in blood constitution should be carefully monitored during PE.Combined immunoglobulin therapy should be considered in cases such as this with aggravated neurological symptoms or decreased plasma constituents such as lipid and globulin after early stage serial PE.