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

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.