Therapeutic Plasma Exchange in Paediatric Intensive Care Unit: A Single Center Experience

INTRODUCTION: Therapeutic plasma exchange (TPE) represents a highly effective extracorporeal blood purification technique for selected indications. It is rarely used in children due to safety concerns such as difficult vascular access, low plasma volume and lack of experienced personnel. Currently it is increasingly recognized as a life-saving treatment in varying conditions. OBJECTIVES: The aim of this study is to share our experience of therapeutic plasma exchange on varying indications in critically ill children who were accepted in our pediatric intensive care unit. MATERIAL AND METHODS: Patients who underwent therapeutic plasma exchange between Jan 2021 and December 2024 in the PICU were included in the study. Demographic, clinical and laboratory data of patients were obtained retrospectively from medical records. A venous catheter was placed in the femoral or jugular veins. The number of plasmapheresis sessions for each patient was determined by observing the course of the disease and clinical improvement. Patients were monitored for vitals during plasma exchange. RESULTS: Total of 34 patients who were hospitalized in our PICU over a 3-year period required TPE. TPE was performed most frequently in hematological diseases (18 patients, 52%) out of which Severe Dengue with TTP was noted to be the most common indication, and neurological diseases (5 patients, 14%). While 10 patients were classified as ASFA category I, one patient as category II, 22 patients as category III, and 5 patients could not be classified. The best response was obtained in hematological diseases. Minor complications were observed in 2 (5%) procedures. There were no serious side effects or deaths associated with TPE in any of the patients. CONCLUSION: TPE appears to be safe from our study, which detected no significant adverse events or deaths linked to it. ASFA criteria may need to be revised as the number of centers performing TPE and the number of experiences increases.