Unidade de Hemoterapia e Hematologia Samaritano, São Paulo, Brazil.
Unidade de Hemoterapia e Hematologia Samaritano, São Paulo, Brazil; Instituto de Tratamento do Câncer Infantil, University of São Paulo School of Medicine, São Paulo, Brazil.
Transfus Apher Sci. 2021 Feb;60(1):103005. doi: 10.1016/j.transci.2020.103005. Epub 2020 Nov 7.
Therapeutic Plasma Exchange (TPE) procedures in pediatric patients are challenging due to the large extracorporeal volume of the cell separators, which were designed for adults. Red blood cell (RBC) priming is an alternative for overpassing the risks of hypovolemia, but data referring to the volume of packed RBCs to be infused are yet incomplete. Restricting the volume of RBC priming may potentially be associated with less transfusion reactions.
To determine the safety of administering a reduced volume of RBC priming for pediatric patients undergoing TPE, in comparison to the standard volume recommended by the cell separators' manufacturers.
This was a case-control study which enrolled 15 pediatric patients undergoing TPE and weighting more than 10Kg. The TPE procedures (n = 406) were divided in two groups: 1) Group1: TPE with ≤150 mL of packed RBC priming and 2) Group2: TPE with 150-250 mL of RBC priming. Groups were compared in terms of hemoglobin / hematocrit and occurrence of adverse reactions.
Group1 and Group2 did not differ significantly in relation to pre- and post-TPE hemoglobin (Hb) levels (p = 0.19 and p = 0.18, respectively). The Δ Hb (Hb pre-TPE - Hb post-TPE) was also not statistically different between the groups. The number of adverse reactions was significantly higher in Group 2 in relation to Group 1 (p = 0.01). The number of allergic reactions was also higher in Group 2 (p = 0.06).
Restricting the volume of RBC priming to less than 150 mL is safe for pediatric patients weighting more than 10Kg and associated with lower rates of transfusion-related adverse reactions.
与细胞分离机制造商推荐的标准体积相比，确定在接受 TPE 的儿科患者中输注减少的 RBC 预充量的安全性。
这是一项病例对照研究，共纳入 15 名体重超过 10kg 的接受 TPE 的儿科患者。将 TPE 程序（n=406）分为两组：1）组 1：TPE 用≤150ml 浓缩红细胞预充，2）组 2：TPE 用 150-250ml RBC 预充。比较两组血红蛋白/血细胞比容和不良反应发生情况。
组 1 和组 2 在 TPE 前后血红蛋白（Hb）水平上无显著差异（分别为 p=0.19 和 p=0.18）。两组间 ΔHb（Hb 预-TPE-Hb 后-TPE）也无统计学差异。与组 1 相比，组 2 的不良反应发生率显著更高（p=0.01）。组 2 的过敏反应发生率也较高（p=0.06）。
对于体重超过 10kg 的儿科患者，将 RBC 预充量限制在 150ml 以下是安全的，与较低的输血相关不良反应发生率相关。
