Tekgunduz Sibel Akpinar, Kara Abdurrahman, Bozkaya Ikbal Oz, Cagli Adnan, Ozbek Namık Yasar
University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Department of Pediatric Hematology and Oncology, Ankara-Turkey.
University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Department of Pediatric Hematology and Oncology and Blood Bank and Apheresis Unit, Ankara-Turkey.
Transfus Apher Sci. 2018 Feb;57(1):20-22. doi: 10.1016/j.transci.2018.02.010. Epub 2018 Feb 21.
The use of therapeutic plasma exchange in the pediatric age group is mostly based on retrospective, single-center experiences. The decision to implement apheresis in pediatric patients is usually adopted from the results of studies on adult patients. In order to expand the limited data on pediatric TPE in general and non-hematooncological disorders in particular, we retrospectively evaluated TPE experience in pediatric patients who underwent the procedure for reasons other than hematooncological disorders. A total of 160 sessions in 34 patients (21 females and 13 males) with a median age of 7 (1-17) were analyzed. Most of the patients had sepsis and organ failure (12 patients, 35 procedures). In only one patient (2.9%) with methyl malonic aciduria (MMA) and sepsis, the procedure was terminated due to a grade 3 allergic reaction. Among the study cohort, 4 patients passed away. No patient died due to complications of TPE. The relatively low discontinuation rate and the lack of procedure-related mortality indicate that TPE is generally well tolerated in the pediatric age group similar to the adult population. However, since there are very limited evidence-based data on TPE use, especially in the pediatric age group, retrospective case series may also be helpful for clinicians in the decision-making process.
治疗性血浆置换在儿科年龄组中的应用大多基于回顾性的单中心经验。儿科患者进行血液分离术的决策通常借鉴成人患者的研究结果。为了扩充关于儿科总体治疗性血浆置换(TPE)尤其是非血液肿瘤性疾病的有限数据,我们回顾性评估了因非血液肿瘤性疾病接受该治疗的儿科患者的TPE经验。共分析了34例患者(21例女性和13例男性)的160次治疗,中位年龄为7岁(1 - 17岁)。大多数患者患有败血症和器官衰竭(12例患者,35次治疗)。仅1例患有甲基丙二酸血症(MMA)和败血症的患者因3级过敏反应终止了治疗。在研究队列中,4例患者死亡。没有患者因TPE并发症死亡。相对较低的终止率和缺乏与治疗相关的死亡率表明,与成人人群类似,儿科年龄组对TPE总体耐受性良好。然而,由于关于TPE使用的循证数据非常有限,尤其是在儿科年龄组中,回顾性病例系列对于临床医生的决策过程可能也有帮助。