Comparison of Adverse Reactions With Solvent/Detergent Treated Plasma Versus Untreated Plasma Use in Therapeutic Plasma Exchange in Pediatric Patients

Solvent/detergent treated plasma (SD plasma) use in therapeutic plasma exchange (TPE) in pediatric patients is not commonly reported. This study aimed to determine transfusion reaction rates using SD plasma and to compare transfusion reaction rates and adverse events when using SD plasma versus untreated plasma in pediatric TPE. A retrospective review was performed on TPE procedures performed at a single institution over a 3-year period. For each TPE procedure, replacement fluid was determined at the discretion of the transfusion medicine physician, consisting of either 5% albumin, untreated plasma, SD plasma, or a combination of untreated or SD plasma with 5% albumin. SD plasma was used in 51 TPE procedures performed on 17 patients. In comparison, untreated plasma was used in 254 procedures in 68 patients. Patient ages ranged from 6 days to 20 years old. With SD plasma use, 1 procedure (2% incidence) reported a non-severe allergic transfusion reaction, compared to 9 procedures (3.5% incidence) with untreated plasma use. These transfusion reaction rates were not statistically different (p = 0.7036, two-tailed Fisher's exact test). Circuit clotting issues were reported in one patient during two discrete TPE procedures utilizing untreated plasma. No other transfusion reactions or adverse events were reported. SD plasma used for TPE was well tolerated, with transfusion reaction rates similar to those observed in untreated plasma in our pediatric patients. SD plasma may be used for TPE in pediatric patients without apparent increased procedure-related risks or increased risks of transfusion reactions compared to untreated plasma.