Therapeutic plasma exchange for life‐threatening pediatric disorders

2021 ◽  
Author(s):  
Jean‐Sebastien Diana ◽  
Sandra Manceau ◽  
Tioka Rabeony ◽  
Caroline Elie ◽  
Valerie Jolaine ◽  
...  
Keyword(s):  
Plasma Exchange ◽  
Therapeutic Plasma Exchange ◽  
Life Threatening ◽  
Pediatric Disorders

scholarly journals Therapeutic plasma exchange in adult critically ill patients with life-threatening SARS-CoV-2 disease: A pilot study

2020 ◽  
Vol 60 ◽  
pp. 328-333 ◽  
Author(s):  
Fahad Faqihi ◽  
Abdulrahman Alharthy ◽  
Mohammed Alodat ◽  
Demetrios J. Kutsogiannis ◽  
Peter G. Brindley ◽  
...  
Keyword(s):  
Pilot Study ◽  
Plasma Exchange ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Therapeutic Plasma Exchange ◽  
Life Threatening

scholarly journals Life-threatening COVID-19 presenting as stroke with antiphospholipid antibodies and low ADAMTS-13 activity, and the role of therapeutic plasma exchange: A case series

2020 ◽  
Vol 8 ◽  
pp. 2050313X2096408
Author(s):  
Abdulrahman Alharthy ◽  
Fahad Faqihi ◽  
Abdullah Balhamar ◽  
Ziad A Memish ◽  
Dimitrios Karakitsos
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Plasma Exchange ◽  
Plasma Volume ◽  
Antiphospholipid Antibodies ◽  
Rescue Therapy ◽  
Antiviral Treatment ◽  
Case Series ◽  
Therapeutic Plasma Exchange ◽  
Life Threatening

We present a case series of three patients with COVID-19 who were admitted to our intensive care unit due to acute respiratory distress syndrome, brain infarction, pulmonary embolism, and antiphospholipid antibodies. We applied therapeutic plasma exchange on all cases. On intensive care unit admission, all patients had low (<10) Glasgow Coma Scale, and central nervous imaging showed multiple brain infarctions. COVID-19 was confirmed by reverse transcriptase polymerase chain reaction assays. Patients underwent rescue therapeutic plasma exchange using the Spectra OptiaTM Apheresis System (Terumo BCT Inc., USA), which operates with acid-citrate dextrose anticoagulant as per Kidney Disease Improving Global Outcomes 2019 guidelines. A dose of 1.5 plasma volume was used for the first dose and then 1 plasma volume daily for a total of five doses. Plasma was replaced with Octaplas LG® (Octapharma AG, USA), which is an artificial fresh frozen plasma product that has undergone viral inactivation by prion reduction technology. We administered ARDS-net/prone positioning ventilation, empiric antiviral treatment, therapeutic anticoagulation, and intensive care unit supportive care. Laboratory tests showed lymphocytopenia; elevated levels of D-dimer, fibrinogen, total bilirubin, C-reactive protein, lactate dehydrogenase, and ferritin; as well as low levels of ADAMTS-13 activity and antibody. Serology tests depicted positive IgM and IgG antiphospholipid antibodies (anti-cardiolipin and anti-β2-glycoprotein I antibodies). No side effects of therapeutic plasma exchange were recorded. After the completion of therapeutic plasma exchange, patients improved clinically and gradually recovered neurologically (after 27–32 days). To conclude, in life-threatening COVID-19, especially when immune dysregulation features such as antiphospholipid antibodies exist, therapeutic plasma exchange could be an effective rescue therapy.

scholarly journals Critical Care COVID-19 Patient with a Picture of Thrombotic Thrombocytopenic Purpura

2020 ◽  
Author(s):  
Rehab AL-Ansari ◽  
Mohanad Bakkar ◽  
Leena Abdalla ◽  
Khaled Sewify
Keyword(s):  
Mechanical Ventilation ◽  
Critical Care ◽  
Plasma Exchange ◽  
Thrombotic Thrombocytopenic Purpura ◽  
Kidney Injury ◽  
Therapeutic Plasma Exchange ◽  
Thrombocytopenic Purpura ◽  
Threatening Condition ◽  
Life Threatening

Background: Thrombotic thrombocytopenic purpura (TTP) is an uncommon haematological disease which can occur at any age and may present with COVID-19. This case describes a COVID-19 complication associated with a presentation resembling TTP. Case description: A 51-year-old man who had received a kidney transplant and was on immunosuppressant medication, was admitted to a critical care unit with severe COVID-19 pneumonia/acute respiratory distress syndrome (ARDS) which required intubation, mechanical ventilation and inotropic support. The course was complicated by the classic pentad of thrombocytopenia, intravascular haemolysis, acute kidney injury, neurological symptoms and fever, which prompted the diagnosis of probable TTP. After five sessions of therapeutic plasma exchange, the patient’s general status improved, he was weaned off mechanical ventilation and his renal panel and haemolytic markers normalized. Conclusion: TTP is a life-threatening condition which requires urgent management with therapeutic plasma exchange. This case highlights some possible complications of COVID-19 generally and in immunocompromised patients specifically. The potential role of plasma exchange in COVID-19 patients without a positive diagnosis of TTP (the so-called ‘TTP resembling presentation’) is an area of further research.

Therapeutic Plasma Exchange in Neonates and Infants: Successful Use of a Miniaturized Machine

2017 ◽  
Vol 44 (2) ◽  
pp. 100-105 ◽  
Author(s):  
Enrico Vidal ◽  
Francesco Garzotto ◽  
Mattia Parolin ◽  
Chiara Manenti ◽  
Anna Zanin ◽  
...  
Keyword(s):  
Plasma Exchange ◽  
Pediatric Population ◽  
Treatment Method ◽  
Therapeutic Plasma Exchange ◽  
Life Saving ◽  
Blood Exchange ◽  
Blood Exchange Transfusion ◽  
Life Threatening ◽  
Technical Issues ◽  
Neonates And Infants

Therapeutic plasma exchange (TPE) in neonates and small infants is a treatment method at the forefront that may become a potentially life-saving procedure in a wide array of severe conditions. Indications for TPE in the pediatric population have been mainly derived from adult literature, with neonatal hyperbilirubinemia being the most notable exception. The only alternative to TPE in small pediatric patients is manual blood exchange transfusion, which, however, bears an unacceptably high risk of severe complications. Still, technical issues due to extracorporeal circulation in neonates have burdened TPE so far, since machines developed for adults require a relatively large blood volume to operate. We in this study, describe our preliminary experience of TPE for treating 2 potentially life-threatening conditions in neonatal age. To overcome the aforementioned limitations, plasmapheresis was performed in both cases using a machine specifically designed for patients weighing less than 10 kg.

scholarly journals Serious acid-base disorder or life-threatening arrhythmia in patients with ABO-incompatible liver transplantation who received therapeutic plasma exchange : A report of two cases

2021 ◽  
Author(s):  
Sangho Lee ◽  
Kyoung-Sun Kim ◽  
Bo-Hyun Sang ◽  
Gyu-Sam Hwang
Keyword(s):  
Plasma Exchange ◽  
Metabolic Alkalosis ◽  
Therapeutic Plasma Exchange ◽  
Acid Base ◽  
Metabolic Derangement ◽  
Surgical Incision ◽  
Electrolyte Disturbance ◽  
Electrolyte Disturbances ◽  
Base Disorder ◽  
Life Threatening

Background: Excessive citrate load during therapeutic plasma exchange (TPE) can cause metabolic alkalosis with compensatory hypercarbia and electrolyte disturbances. If TPE is required immediately before ABO-incompatible (ABOi) liver transplant (LT) surgery, metabolic derangement and severe electrolyte disturbance could worsen during LT anesthesia.Case: We report two ABOi LT cases who received TPE on the day of surgery because isoagglutinin titers did not be dropped below 1:8. One case had a surprisingly high metabolic alkalosis with a pH of 7.73 immediately after tracheal intubation because of hyperventilation during mask bagging. The other experienced sudden ventricular tachycardia and blood pressure drop after surgical incision accompanied with severe hypokalemia of 1.8 mmol/L despite supplementation with potassium.Conclusions: Special attention should be paid to patients who just completed TPE the operative day morning as they are vulnerable to severe acid-base disturbances and life-threatening ventricular arrhythmias in ABOi LT.

scholarly journals Therapeutic Plasma Exchange in Pediatrics for Immunologic Disorders; Tolerated and Safe Process for Pediatric Life-Threatening Conditions

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4986-4986
Author(s):  
Jean-Sebastien Diana ◽  
Sandra Manceau ◽  
Tioka Rabeony ◽  
Caroline Elie ◽  
anne-Marine Lenzotti ◽  
...  
Keyword(s):  
Plasma Exchange ◽  
Inflammatory Diseases ◽  
Therapeutic Plasma Exchange ◽  
Renal Diseases ◽  
Case Report Form ◽  
Solid Organ ◽  
Immune Disorder ◽  
Antibody Mediated Rejection ◽  
Increased Risk ◽  
Life Threatening

Therapeutic plasma exchange (TPE) is advocated as a treatment to several conditions and applications: solid organs transplantation, kidney and pediatric immune disorder. Apheresis for children diseases has been poorly investigated in mostly small, uncontrolled studies.The purpose was to report our experience, and provide uniform and relatable data, in order to improve disease management. We included 94 patients, aged under 18 years old, who underwent TPE in the pediatric center of Necker-Enfants-Malades hospital from January 2005 to December 2014. Data were retrospectively collected in an electronic case report form via a web-based data collection system. 78 patients were selected, including 36 females and 42 males with a median age of 9.78 years [range 0.53; 17.93]. They achieved a total number of 731 procedures. Indications were antibody-mediated rejection (n= 33; 42%) or desensitization therapy (n= 5; 6%) for solid organ or hematopoietic transplantations; microangiopathy (n= 17; 22%); renal diseases (n= 6; 8%) and pediatric inflammatory diseases (n= 16; 21%); or hyperviscosity syndrome (n = 1; 1%). Each patient had an average of 6 procedures for the first session [range 1; 19] with a median volume of 1834 ml [range 500; 5000 ml] corresponding to a median total plasma volume (TPV) equivalent of 1.39 l/m2[range: 0.58; 2.1 l/m2].Within 15 days in the beginning of the sessions, 72 patients (92%) presented a total of 311 Advers Events(AEs) potentially related to TPE. 94 AEs were not related to TPE sessions.There was a median of 5 AEs/patients [range: 0; 24]. There was no significant increased risk of AEs due to diseases, intensity of care, venous access, plasma substitute and body weight. Few of AEs were potentially life-threatening and concerned pediatric critical care situations. Allergic reactions represented only 20 AEs for 14 patients (grade I n= 18; grade II n= 1; grade III n= 1). At the endpoint of M12, 15 (19%) patients had died, no death had been related to the TPE process. Nine patients performed a second or a third session of procedures and 10 (13%) patients had severe persistent clinical disease. We describe one of the largest retrospective pediatric cohort to date, to the last international recommendations. Our experience on children TPE feasibility concern specific life‐threatening conditions and otherwise potential refractory diseases. TPE were generally well tolerated and the majority of the adverse effects were anticipated and could therefore be avoided. Based on this work, and in order to progress in the understanding of the TPE field, it would be interesting to increase pediatric data with prospective and multicenter cohort. Disclosures Cavazzana: Smartimmune: Other: Founder of Smartimmune.

scholarly journals Therapeutic Plasma Exchange in Patients with Systemic Lupus Erythematosus

2020 ◽  
Vol 20 (02) ◽  
pp. 65-70
Author(s):  
Cheuk Man Ho ◽  
Chi Chiu Mok
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Plasma Exchange ◽  
Lupus Erythematosus ◽  
Organ Damage ◽  
Therapeutic Plasma Exchange ◽  
Current Evidence ◽  
Systemic Lupus ◽  
Level Of Evidence ◽  
Multiple Systems ◽  
Life Threatening

Systemic lupus erythematosus (SLE) is an autoimmune disease with involvement of multiple systems. Despite the therapeutic advances in the past few decades, refractory SLE causing organ damage and life-threatening complications still poses a therapeutic challenge. Therapeutic plasma exchange is considered as one of the rescue therapies used in refractory SLE. However, the level of evidence supporting its use is low. This article reviews the current evidence of the application of plasmapheresis in the treatment of SLE.

scholarly journals Treatment of thrombotic thrombocytopenic purpura beyond therapeutic plasma exchange

Hematology ◽  
2015 ◽  
Vol 2015 (1) ◽  
pp. 637-643 ◽  
Author(s):  
Paul Coppo ◽  
Antoine Froissart
Keyword(s):  
Plasma Exchange ◽  
Thrombotic Thrombocytopenic Purpura ◽  
Survival Rates ◽  
Therapeutic Plasma Exchange ◽  
Response To Treatment ◽  
Thrombocytopenic Purpura ◽  
Therapeutic Landscape ◽  
Life Threatening ◽  
Adamts13 Deficiency ◽  
Von Willebrand

Abstract Daily therapeutic plasma exchange (TPE) transformed the historically fatal prognosis of acquired, anti-ADAMTS13 antibody-mediated thrombotic thrombocytopenic purpura (TTP), leading to the current overall survival rates of 80%-85%. However, relapses occur in ∼40% of patients and refractory disease with fatal outcomes still occurs. In this context, the introduction of rituximab has probably been the second major breakthrough in TTP management. Rituximab is now routinely recommended during the acute phase, typically in patients with a suboptimal response to treatment, or even as frontline therapy, with high response rates. In more severe patients, salvage strategies may include twice-daily TPE, pulses of cyclophosphamide, vincristine, as well as splenectomy in more desperate cases. In this life-threatening disease, relapse prevention represents a major goal. Persistent severe acquired ADAMTS13 deficiency in patients who are otherwise in remission is associated with a high risk of relapse and preemptive treatment with rituximab may be considered in this context. In the coming years, the TTP therapeutic landscape should be enriched by original strategies stemming from clinical experience and new agents that are currently being evaluated in large, ideally international, clinical trials. Promising agents under evaluation include N-acetylcysteine, bortezomib, recombinant ADAMTS13, and inhibitors of the glycoprotein-Ib/IX-von Willebrand factor axis.

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