Plasma exchange combined continuous veno-venous hemodiafiltration in the treatment of critical hemolytic uremic syndrome

Abstract

Objective To investigate the efficacy of bedside plasma exchange(PE) combined continuous veno-venous hemodiafiltration(CVVHDF) in children with critical hemolytic uremic syndrome(HUS). Methods Eight patients with HUS from Pediatric Intensive Care Unit of Shanghai Children′s Hospital were included in the present study.The severity of children was graded according to pediatric critical illness score and pediatric risk of score mortality Ⅲ.Four of them received continuous blood purification treatment.Meanwhile, the clinical manifestation and outcome of HUS were analyzed. Results Eight children with HUS were initially treated with diuretic and blood transfusion for 12-24 hours.Four cases who deteriorated aggressively were performed PE and CVVHDF.Plasauto iQ21 and Prisma flex were used with Prisma TPE 2000 membrane plasma separator and AN69 M60 membrane filter respectively.All the 4 patients with critical HUS survived after bedside continuous blood purification treatment.Clinical symptoms and serum biochemistry were improved significantly as follows.The average levels of serum creatinine and lactate dehydrogenase decreased obviously(318 μmol/L vs. 162 μmol/L; 1 963 U/L vs. 407 U/L, respectively). In addition, platelet count increased significantly(40×109/L vs. 97×109/L). Eventually, symptoms disappeared in these 4 patients. Conclusion The combined therapy of PE and CVVHDF in HUS could stabilize fluid acid-base equilibrium, prevent hemolysis and improve the renal function. Key words: Plasma exchange; Continuous veno-venous hemodiafiltration; Hemolytic uremic syndrome; Critically ill; Children