Training and Practice Gaps in Pediatric Apheresis in Canada: A National Survey

Abstract

This study explored the pediatric apheresis landscape in Canada by assessing provider comfort, training adequacy, and prescriber roles for therapeutic plasma exchange (TPE) and automated red blood cell exchange (RBCX). A national survey was completed by 52 pediatric subspecialists (27 nephrologists, 25 hematologists/oncologists) from 12 institutions. Most respondents (63%) reported that both TPE and RBCX were available at their site. Prescribing responsibilities varied by therapy and indication. Across seven clinical domains, comfort scores were moderate for both therapies, with training adequacy scores consistently lower. Training adequacy for TPE was significantly higher than that for RBCX in two domains: identifying (2.48 ± 1.03 vs. 2.10 ± 1.13, p = 0.043) and managing (2.44 ± 1.05 vs. 2.06 ± 1.14, p = 0.035) common complications. Free-text responses emphasized informal training and the need for national education strategies. These findings highlight gaps in pediatric apheresis education and the need for standardized, competency-based training across subspecialties.