Abstract
Therapeutic plasma exchange (TPE) is now widely used in therapy of multiple diseases in children, by removing the plasma with pathogenic agents from patients. However, adverse reactions may limit its application.A retrospective cohort study of 435 hospitalized children treated with 1201 plasma exchange procedures between January 2013 and July 2018 were enrolled.Complications occurred in 152 procedures (12.7%); 90 procedures (7.5%) had ≥2 complications. No death occurred. The most common complications were pruritus and urticaria (7%), followed by hypertension (1.92%) and hypotension (1.17%). One child had an outbreak of disseminated cryptococcosis neoformans infection, another child developed anaphylactic shock, and 3 children presented toxic epidermal necrolysis after TPE. The incidence of pruritus and urticaria was higher in children of the 6∼15 year group (P < .05) compared with other age groups. There was no significant difference in the incidence of hypertension and hypotension in children at different ages and weights (P > .05). Compared with other diseases, anti-N-methyl-d-aspartate (anti-NMDA) receptor encephalitis led to a higher incidence of complications in children (P < .05).The results suggest that TPE is a relatively safe procedure for children, and most of the complications are mild. The most common complication is pruritus and urticaria. However, serious complications such as toxic epidermal necrolysis and infection should still be taken seriously.
Highlights
The therapeutic plasma exchange (TPE) is a therapy in which plasma is separated from the blood cellular components ex vivo, discarded and replaced with an isosmotic fluid to maintain appropriate oncoticEditor: Girish Chandra Bhatt
The results suggest that TPE is a relatively safe procedure for children, and most of the complications are mild
During 5 years, 1201 TPE treatments were performed on a total of 435 children, including 198 males (45.5%) and 237 females
Summary
A series of hospitalized children who underwent at least 1 TPE procedure between January 2013 and July 2018 were enrolled. Treatment was performed according to the blood purification standard operating procedure of TPE in China, which included establishing appropriate vascular access for corresponding age, plasma dose prescription, anticoagulation of the circuit, and so on. Each TPE treatment will remove plasma which is approximately 5% of the child’s body weight and an equal amount of FFP was used as a replacement, the total amount does not exceed 3000 mL. All children received intravenous calcium supplementation to prevent hypocalcemia caused by citrate in plasma preservation solutions, the dose was 2 mL of 10% calcium gluconate solution per each 250 mL FFP. In the course of treatment, the children were given intravenous infusion of dexamethasone (0.5 mg/kg, maximum 20 mg) to prevent allergy
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