Scope, Safety, and Feasibility of Therapeutic Plasma Exchange in Pediatric Intensive Care Unit: A Single-center Experience

Karthik Kumar Balasubramanian; Priyavarthini Venkatachalapathy; Saravanan Margabandhu; Rajeshwari Natraj; Vasanth Kumar Sridaran; Chidhambharam Lakshmanan; Suchitra Ranjit

doi:10.5005/jp-journals-10071-24541

Scope, Safety, and Feasibility of Therapeutic Plasma Exchange in Pediatric Intensive Care Unit: A Single-center Experience

Indian J Crit Care Med. 2023 Oct;27(10):766-770. doi: 10.5005/jp-journals-10071-24541.

Authors

Karthik Kumar Balasubramanian¹, Priyavarthini Venkatachalapathy¹, Saravanan Margabandhu², Rajeshwari Natraj¹, Vasanth Kumar Sridaran¹, Chidhambharam Lakshmanan¹, Suchitra Ranjit¹

Affiliations

¹ Department of Paediatric Intensive Care Unit, Apollo Cradle & Children's Hospital, Chennai, Tamil Nadu, India.
² Department of Nephrology, Apollo Hospitals, Chennai, Tamil Nadu, India.

Abstract

Background: Indications for therapeutic plasma exchange (TPE) in the pediatric intensive care unit (PICU) are expanding. We aimed to study the demographics, clinical indications, and outcomes of patients who have undergone TPE in our PICU.

Materials and methods: This is a retrospective study performed among children aged from 1 month to 16 years of age. Demographics, indications, therapeutic response, serious adverse events (SAE), PICU length of stay (LOS), and death during hospitalization were studied as outcome variables.

Results: Therapeutic plasma exchange was performed in 115 sessions on 24 patients for 12 different indications falling under various American Society for Apheresis (ASFA) categories. Therapeutic plasma exchange was performed on ten, four, and ten children for ASFA category I, II, and III indications, respectively. The most common indications were thrombotic microangiopathy (TMA) (8/24) and acute liver failure (ALF) (6/24). During those 115 sessions, a total of five serious adverse events (SAEs) occurred, accounting for 4.3% of the cases. Minor adverse events occurred in 12 sessions (10.4%). Therapeutic response was good in 17 patients (71%) including 5 patients who underwent standard volume TPE (SV-TPE) for ALF. Median PICU LOS was 9 (range 2-120) days. The mortality rate was 12.5% (3/24).

Conclusion: Therapeutic plasma exchange is effective in various clinical conditions involving various organ systems. It is an excellent therapeutic modality in children with ALF, irrespective of the exchange volume and TMA. However, SAEs do occur in the minority.

How to cite this article: Balasubramanian KK, Venkatachalapathy P, Margabandhu S, Natraj R, Sridaran VK, Lakshmanan C, et al. Scope, Safety, and Feasibility of Therapeutic Plasma Exchange in Pediatric Intensive Care Unit: A Single-center Experience. Indian J Crit Care Med 2023;27(10):766-770.

Keywords: Acute liver failure; American society for apheresis; Paediatric Intensive care; Plasmapheresis; Therapeutic plasma exchange; Thrombotic microangiopathy.