scholarly journals The Role of Therapeutic Plasma Exchange (TPE) in Multisystem Inflammatory Syndrome in Children (MIS-C)

Children ◽  
2021 ◽  
Vol 8 (6) ◽  
pp. 498
Author(s):  
Gurkan Atay ◽  
Canan Hasbal ◽  
Mücahit Türk ◽  
Seher Erdoğan ◽  
Betül Sözeri
Keyword(s):  
Plasma Exchange ◽  
Clinical Laboratory ◽  
Invasive Mechanical Ventilation ◽  
Pediatric Intensive Care ◽  
Tertiary Hospital ◽  
Therapeutic Plasma Exchange ◽  
Group 2 ◽  
Inflammatory Syndrome ◽  
Admission Group

Multisystemic inflammatory syndrome in children (MIS-C) is a new potentially life-threatening disease that is related to coronavirus disease 2019 (COVID-19). The aim of this study is to reveal the clinical and laboratory results of MIS-C and the role of therapeutic plasma exchange (TPE) in its treatment. Clinical, laboratory and radiological characteristics of the patients who were admitted to the pediatric ward and pediatric intensive care unit (PICU) of a tertiary hospital with a diagnosis of MIS-C between April 2020 and March 2021 were included in the study. Forty-one patients were admitted to our hospital with a diagnosis of MIS-C. Twenty-one (51.2%) patients were admitted to the PICU. Six patients needed invasive mechanical ventilation (14.6%), 10 patients (24.4%) TPE and 3 patients (7.3%) needed extracorporeal membrane oxygenation (ECMO). The patients were grouped according to need for PICU admission (Group 1: no need for PICU, Group 2: need for PICU admission). Group 2 had significantly higher levels of C-reactive protein (CRP), alanine aminotransferase (ALT), ferritin, D-dimer, pro-B type natriuretic peptide (pro BNP) and lactate (p < 0.05). Hyponatremia found to be an independent risk factor for inpatient MIS-C in the PICU. We think that dynamic laboratory trending is beneficial in determining the need for PICU admission and TPE may be effective in critically ill patients.

Therapeutic Plasma Exchange Application in Children Requires Individual Decision

2020 ◽  
Author(s):  
Gürkan Atay ◽  
Demet Demirkol
Keyword(s):  
Plasma Exchange ◽  
Vascular Access ◽  
Pediatric Patients ◽  
Demyelinating Disease ◽  
Pediatric Intensive Care ◽  
Therapeutic Plasma Exchange ◽  
Transplantation Rejection ◽  
Access Problems ◽  
Uremic Syndrome

AbstractTherapeutic plasma exchange (TPE) is a treatment administered with the aim of removing a pathogenic material or compound causing morbidity in a variety of neurologic, hematologic, renal, and autoimmune diseases. In this study, we aimed to assess the indications, efficacy, reliability, complications, and treatment response of pediatric patients for TPE. This retrospective study analyzed data from 39 patients aged from 0 to 18 years who underwent a total of 172 TPE sessions from January 2015 to April 2018 in a tertiary pediatric intensive care unit. Indications for TPE were, in order of frequency, macrophage activation syndrome (28.2%, n = 11), renal transplantation rejection (15.4%, n = 6), liver failure (15.4%, n = 6), Guillain–Barre's syndrome (15%, n = 6), hemolytic uremic syndrome (7.7%, n = 3), acute demyelinating disease (7.7%, n = 3), septic shock (5.1%, n = 2), and intoxication (5.1%, n = 2). No patient had any adverse event related to the TPE during the procedure. The TPE session was ended prematurely in one patient due to insufficient vascular access and lack of blood flow (2.6%). In the long term, thrombosis due to the indwelling central catheter occurred (5.1%, n = 2). TPE appears to be an effective first-stage or supplementary treatment in a variety of diseases, may be safely used in pediatric patients, and there are significant findings that its area of use will increase. In experienced hands and when assessed carefully, it appears that the rate of adverse reactions and vascular access problems may be low enough to be negligible.

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 On Whether Therapeutic Plasma Exchange is Effective Against Severe/Critical COVID-19 Pneumonia

2021 ◽  
Author(s):  
Luca Cegolon ◽  
Behzad Einollahi ◽  
Sina Imanizadeh ◽  
Mohammad Rezapour ◽  
Mohammad Javanbakht ◽  
...  
Keyword(s):  
Plasma Exchange ◽  
Structural Equation ◽  
Cox Regression ◽  
Controlled Trial ◽  
Therapeutic Plasma Exchange ◽  
Equation Modeling ◽  
Control Group ◽  
P Value ◽  
Group 2 ◽  
Group 1

Abstract Background. There is a risk of novel mutations of SARS-CoV-2 that may render COVID-19 resistant to most of the therapies, including antiviral drugs. The evidence around the application of therapeutic plasma exchange (TPE) for the management of critically ill COVID-19 patients is still provisional and further investigations are needed to confirm its eventual beneficial effects. Methods. We therefore carried out a single-centered retrospective observational non-placebo-controlled trial enrolling 73 inpatients from Baqiyatallah Hospital in Tehran (Iran) with diagnosis of COVID-19 pneumonia confirmed by real-time polymerase chain reaction (RT-PCR) on nasopharyngeal swabs and high-resolution computerized tomography chest scan. These patients were broken down into two groups: Group 1 (30 patients) receiving standard of care (corticosteroids, ceftriaxone, azithromycin, pantoprazole, hydroxychloroquine, lopinavir/ritonavir); and Group 2 (43 patients) receiving the above regimen plus TPE (replacing 2 liter of patients’ plasma by a solution, 50% of normal plasma and 50% of albumin at 5%) administered according to various time schedules. The follow-up time was 30 days and all-cause mortality was the endpoint. Results. Deaths were 6 (14%) in Group 2 and 14 (47%) in Group 1. However, different harmful risk factors prevailed among patients not receiving TPE rather than being equally split between the intervention and control group. We used an algorithm of Structural Equation Modeling (of STATA) to summarize a large pool of potential confounders into a single score (called with the descriptive name “severity”). Disease severity was significantly (Wilkinson rank sum test p-value=0.0000) lower among COVID-19 patients undergoing TPE (median: -2.82; range: -5.18; 7.96) as compared to those non receiving TPE (median: -1.35; range: -3.89; 8.84), confirming that treatment assignment involved a selection bias of patients according to the severity of COVID-19 at hospital admission. The adjustment for confounding was carried out using severity as covariate in Cox regression models. The univariate Hazard Ratio (HR) of 0.68 (95%CI: 0.26; 1.80; p=0.441) for TPE turned to 1.19 (95%CI: 0.43; 3.29; p=0.741) after adjusting for severity. Conclusions. The lower mortality observed among patients receiving TPE was due to a lower severity of COVID-19 rather than TPE effects. TRIAL REGISTRATIONIRCT registration number: IRCT20080901001165N58 (Iranian Registry of Clinical Trials)Registration date: 2020-05-27, 1399/03/07 (retrospectively registered)

Therapeutic Plasma Exchange for Acute Hematologic Disorders

2019 ◽  
pp. 359-362
Author(s):  
Jill Adamski
Keyword(s):  
Plasma Exchange ◽  
Blood Cells ◽  
Critical Care Unit ◽  
White Blood Cells ◽  
Buffy Coat ◽  
Therapeutic Plasma Exchange ◽  
Blood Components ◽  
Hematologic Disorders ◽  
First Line Therapy

Therapeutic plasma exchange (TPE) is a process by which whole blood is removed from a patient and separated into 3 components: red blood cells, white blood cells (buffy coat), and plasma. After separation, the plasma is discarded, and the other blood components are returned to the patient along with exogenous fluid to replace the removed plasma. TPE is an important tool to remove pathogenic substances (eg, antibodies) from plasma, and this technique is considered first-line therapy for numerous conditions that affect patients in the critical care unit. This chapter describes the role of TPE in management of hematologic disorders, some of which have neurologic manifestations.

Iatrogenic thyrotoxicosis and the role of therapeutic plasma exchange

2017 ◽  
Vol 32 (6) ◽  
pp. 579-583 ◽  
Author(s):  
Kabeer K. Shah ◽  
Michael M. Mbughuni ◽  
Edwin A. Burgstaler ◽  
Darci R. Block ◽  
Jeffrey L. Winters
Keyword(s):  
Plasma Exchange ◽  
Therapeutic Plasma Exchange
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