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 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.

scholarly journals Study of changes in the blood levels of copper and zinc following the blood exchange transfusion in neonates with hyperbilirubinemia

2016 ◽  
Vol 2 (7) ◽  
pp. 138
Author(s):  
Mehrdad Mirzarahimi ◽  
Afsaneh Enteshari-Moghaddam ◽  
Raheleh Asghari Moghaddam ◽  
Abbas Naghizade ◽  
Mohammad Mazani
Keyword(s):  
Exchange Transfusion ◽  
Serum Bilirubin ◽  
Newborn Infants ◽  
Treatment Method ◽  
Blood Levels ◽  
Zn Concentration ◽  
Blood Exchange ◽  
Blood Exchange Transfusion ◽  
Serum Zn ◽  
Before And After

<p class="abstract"><strong>Background:</strong> Blood exchange transfusion (EXT) is an essential treatment method in some icteric newborns and causes some changes in trace elements in them. The effects of blood exchange transfusion on zinc (Zn) and copper (Cu) in newborn infants is unknown. This study was conducted to determine the possible effects of EXT on Zn and Cu by comparing the levels of Zn and Cu in jaundiced neonates.</p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">In this study, 30 jaundiced term neonates undergoing EXT for the first time, because of idiopathic unconjugated hyperbilirubinemia, were selected. The Zn and Cu levels of 30 blood bank donors’ samples used for EXT were measured and 30 pairs of umbilical cord blood samples were examined for Zn and Cu before and one hour and five days after exchange transfusion. The serum bilirubin concentration was measured before and after EXT. The collected data in laboratory were analysed by statistical methods using SPSS.19. </span></p><p class="abstract"><strong>Results:</strong> In this study 43% were girls and 56.7% were boys and the average age of the infants was 4.56 days at the time of admission. Before EXT, the average of serum bilirubin was 27.74±2.03 mg/dl, and the average of serum Zn was 48.53±4.94 μg/dl that was lower than serum Zn concentration one hour after EXT (55.98±7.60 μg/dl) and five days after EXT (56.63±10.92 μg/dl). This difference was statistically significant (P=0.001). Furthermore, the average of serum Cu concentration was 59.56±10.92 μg/dl before EXT, 60.48±10.05 μg/dl after EXT and 58.64±8.06 μg/dl five days after EXT that didn't vary significantly from each other.</p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">The results showed that after EXT, the serum Zn concentration was higher than before EXT but the changes in serum Cu concentration was little and negligible. </span></p>

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.

Therapeutic plasma exchange with albumin as a valuable method of preparing thyrotoxic patients for a life‐saving thyroidectomy

2020 ◽  
Author(s):  
Kamila Tańska ◽  
Dorota Leszczyńska ◽  
Piotr Glinicki ◽  
Renata Kapuścińska ◽  
Marek Szczepkowski ◽  
...  
Keyword(s):  
Plasma Exchange ◽  
Therapeutic Plasma Exchange ◽  
Life Saving ◽  
Valuable Method

A life-saving therapy in Class I HELLP syndrome: Therapeutic plasma exchange

2015 ◽  
Vol 52 (2) ◽  
pp. 194-198 ◽  
Author(s):  
Mehmet Ali Erkurt ◽  
Ilhami Berber ◽  
Hacı Bayram Berktas ◽  
Irfan Kuku ◽  
Emin Kaya ◽  
...  
Keyword(s):  
Plasma Exchange ◽  
Hellp Syndrome ◽  
Therapeutic Plasma Exchange ◽  
Class I ◽  
Life Saving

scholarly journals Percutaneous coronary intervention in four month old infant for acute myocardial ischemia after repaired ALCAPA

2019 ◽  
Author(s):  
Mirsad Kacila ◽  
Mirza Halimic ◽  
Merjema Karavdic ◽  
Almira Kadic ◽  
Sasa Lukic ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Left Coronary Artery ◽  
Pediatric Population ◽  
Coronary Intervention ◽  
Life Saving ◽  
Percutaneous Coronary ◽  
Threatening Condition ◽  
Coronary Artery Diameter ◽  
Life Threatening

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is rare, but life-threatening condition. The treatment of choice in patients with ALCAPA is the establishment of a dual coronary artery system with surgical reimplantation of the left coronary artery in the left coronary sinus. Percutaneous coronary intervention is infrequent in the pediatric population but can be a life-saving by promptly restoring flow to an obstructed coronary artery. It is a highly demanding and high-risk procedure in infants due to the technical difficulties and the small coronary artery diameter in infants.

scholarly journals Therapeutic plasma exchange: A life-saving modality in Wegener's granulomatosis

2020 ◽  
Vol 14 (2) ◽  
pp. 203
Author(s):  
Tulika Chandra ◽  
Archana Solanki ◽  
Ashutosh Singh ◽  
Abhishek Chauhan ◽  
D Himanshu
Keyword(s):  
Plasma Exchange ◽  
Wegener’S Granulomatosis ◽  
Wegener's Granulomatosis ◽  
Therapeutic Plasma Exchange ◽  
Life Saving
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