Therapeutic plasma exchange as treatment modality in pediatric patients with neurologic and nonneurologic diseases at the Philippine Children's Medical Center: A 12-year single center experience

IF 1.4 4区医学 Q4 HEMATOLOGY

Journal of Clinical Apheresis Pub Date : 2024-06-22 DOI:10.1002/jca.22137

Alexander B. Suplico Jr, Maria Beatriz P. Gepte

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引用次数: 0

Abstract

Objective

To determine the clinical characteristics, indications, technical aspects, complications, and outcomes of therapeutic plasma exchange (TPE) procedures performed in pediatric patients with neurologic and nonneurologic diseases at the Philippine Children's Medical Center during a 12-year period (January 2010–March 2023).

Materials and Methods

All TPE performed between January 2010 and March 2023 were retrospectively evaluated. The indications for TPE were classified according to the 2019 American Society for Apheresis (ASFA) categorization.

Results

Fifty-seven patients underwent a total of 297 TPE procedures. The median age was 12 years (2–18), with 51% male (n = 29) and 49% female (n = 28). The most common indication was N-methyl-d-aspartate receptor antibody encephalitis, accounting for 54% of cases (n = 31), followed by Guillain-Barré syndrome at 16% (n = 9), Hemolytic Uremic Syndrome at 7% (n = 4), and Sepsis with multiorgan failure at 7% (n = 4). Forty-one patients (71.8%) were classified under ASFA category 1, seven (12.4%) as category II, and nine (15.8%) as category III. All TPE procedures were conducted using the centrifugation technique and citrate anticoagulation. Ninety-nine percent of the procedures were performed through the internal jugular vein. Albumin was utilized as a replacement fluid in 88% of the procedures. Most complications were related to patient factors and occurred in 10% of cases (n = 31), while problems associated with the extracorporeal circuit were observed in only 4.37% of cases (n = 13). Overall response rate was 91% and there was no TPE-related deaths. No clear association was found between clinical responses to TPE and specific diagnoses within ASFA categories.

Conclusion

TPE is a safe and effective adjuvant treatment for pediatric patients with neurologic and nonneurologic diseases. The outcome in these patients requiring TPE is excellent. However, response varies with failed organs and the need for life-sustaining therapies.

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菲律宾儿童医疗中心将治疗性血浆置换作为神经系统和非神经系统疾病儿科患者的治疗方式：12年的单一中心经验

目的确定菲律宾儿童医学中心在 12 年内（2010 年 1 月至 2023 年 3 月）为患有神经系统疾病和非神经系统疾病的儿科患者实施的治疗性血浆置换术（TPE）的临床特征、适应症、技术方面、并发症和疗效。材料与方法对 2010 年 1 月至 2023 年 3 月期间实施的所有 TPE 进行了回顾性评估。TPE的适应症根据2019年美国血液净化协会（ASFA）的分类进行了分类。结果 57名患者共接受了297例TPE手术。中位年龄为12岁（2-18岁），51%为男性（n = 29），49%为女性（n = 28）。最常见的适应症是N-甲基-d-天冬氨酸受体抗体脑炎，占病例数的54%（n = 31），其次是格林-巴利综合征，占16%（n = 9），溶血性尿毒症综合征占7%（n = 4），败血症合并多器官功能衰竭占7%（n = 4）。41 名患者（71.8%）被归入 ASFA 第一类，7 名（12.4%）被归入第二类，9 名（15.8%）被归入第三类。所有 TPE 手术均采用离心技术和枸橼酸盐抗凝法。99%的手术通过颈内静脉进行。88%的手术使用白蛋白作为置换液。大多数并发症与患者因素有关，发生率为 10%（31 例），而与体外循环有关的问题仅占 4.37%（13 例）。总体反应率为 91%，没有出现与 TPE 相关的死亡病例。对 TPE 的临床反应与 ASFA 类别中的特定诊断之间没有明显关联。结论 TPE 是一种安全有效的辅助治疗方法，适用于患有神经系统疾病和非神经系统疾病的儿科患者。这些需要接受 TPE 治疗的患者疗效极佳。但是，反应因器官衰竭和对维持生命疗法的需求而异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Apheresis 医学-血液学

CiteScore

2.80

自引率

13.30%

发文量

审稿时长

>12 weeks

期刊介绍： The Journal of Clinical Apheresis publishes articles dealing with all aspects of hemapheresis. Articles welcomed for review include those reporting basic research and clinical applications of therapeutic plasma exchange, therapeutic cytapheresis, therapeutic absorption, blood component collection and transfusion, donor recruitment and safety, administration of hemapheresis centers, and innovative applications of hemapheresis technology. Experimental studies, clinical trials, case reports, and concise reviews will be welcomed.