Experiences with plasmapheresis in our pediatric dialysis unit

L. Koster-Kamphuis, E. Cornelissen, E. Levtchenko, N. van de Kar

Dept. of Pediatric Nephrology

University Children’s Hospital Nijmegen

The Netherlands

Introduction

• Extracorporeal therapy

• Therapeutic Plasma Exchange (TPE)

• Replacement fluid– Fresh frozen plasma– Albumin

Introduction

• Vascular access

• Anticoagulation

• Adapted machinery

• Blood priming

Introduction

• Removal of (auto)antibodies, immune complexes

• Intoxication (protein bound)

• Removal of protein bound medication

• Hyper viscosity (Para proteins)

• > 15000 Dalton

Methods

• Membrane filtration

• AK 100 with PF 1000 filter

• PRISMA with TPE 2000 filter

• Fresh frozen plasma or Albumin

• Heparin anticoagulation

MethodsPF 1000 TPE 2000

Machine AK 100 PRISMA

Surface area (m2)

0,15 0,35

Extracorporeal volume (ml)

90 (23 ml filter + 70-80 ml lines)

90 (set with filter and lines)

Access Single or double

(single pump)

double

Bloodflow <200 ml/min >100 ml/min

Methods

Choice of replacement fluid

Fresh frozen plasma when substitution of plasma components is needed

Albumin solution when removal of the plasma is beneficial due to disease causing factors in the plasma

Patients

• N=16

• Age 4 months- 18 years

• Weight 7-67 kg

Patients

• Atypical HUS (n=7)• Recurrent NS after transplantation (n=3)• Anti-GBM nephritis (n=1)• Wegeners Granulomatosis (n=1)• Guillain-Barré (n=1)• Myasthenia Gravis (n=1)• ADEM (n=1)• Progressive necrotizing encephalopathy (n=1)

Results

• Positive effectAtypical HUS

Myasthenia Gravis

Wegeners granulomatosis

Recurrent NS after transplantation (n=2)

Results

• No effectAnti-GBM nephritis

Progressive necrotizing encephalopathy

Results

• Possible or some effectGuillain-Barré

ADEM

Recurrent NS after transplantation (n=1)

Complications

• Allergic reactions

• Hypocalcaemia

• Hypotension

• Access problems

• Catheter related problemsInfection

Clotting

Conclusion

• TPE is a useful treatment in infants and children for a wide range of indications

• TPE is a specific treatment modality that fits in the program of a dialysis unit