Experiences with plasmapheresis in our pediatric dialysis unit L. Koster-Kamphuis, E. Cornelissen, E. Levtchenko, N. van de Kar Dept. of Pediatric Nephrology.

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Presentation transcript:

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) > Dalton

Methods Membrane filtration AK 100 with PF 1000 filter PRISMA with TPE 2000 filter Fresh frozen plasma or Albumin Heparin anticoagulation

Methods PF 1000TPE 2000 MachineAK 100PRISMA Surface area (m 2 ) 0,150,35 Extracorporeal volume (ml) 90 (23 ml filter ml lines) 90 (set with filter and lines) AccessSingle 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 effect Atypical HUS Myasthenia Gravis Wegeners granulomatosis Recurrent NS after transplantation (n=2)

Results No effect Anti-GBM nephritis Progressive necrotizing encephalopathy

Results Possible or some effect Guillain-Barré ADEM Recurrent NS after transplantation (n=1)

Complications Allergic reactions Hypocalcaemia Hypotension Access problems Catheter related problems Infection 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