Therapeutic plasma exchange in pediatric patients with acute demyelinating syndromes of the central nervous system: A single-center experience |
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| Institution: | 1. Pediatric Intensivist, Pediatric Intensive Care, University of Health Sciences Turkey, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey;2. Pediatric Neurology, University of Health Sciences Turkey, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey;3. Pediatric Intensivist, Pediatric Intensive Care, University of Health Sciences Turkey, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey;4. Pediatric Intensivist, Chief of the Pediatric Intensive Care Unit, University of Health Sciences Turkey, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey;1. Division of Transfusion Medicine, Department of Pathology, Microbiology and Immunology. Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA;2. Vanderbilt Pathology Program in Global Health, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA;3. Division of Hematology-Oncology, Department of Internal Medicine, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA;1. Department of Hematology, Instituto de Investigación Sanitaria San Carlos (IdISSC), Hospital Clínico San Carlos (HCSC), Madrid, Spain;2. Department of Emergency, Instituto de Investigación Sanitaria San Carlos (IdISSC), Hospital Clínico San Carlos (HCSC), Madrid, Spain;3. Platelet Research Lab, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain;4. Dept. of Blood Cell Research, Sanquin Research and Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands;5. Dept. of Molecular Hematology, Sanquin Research and Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands;6. Institute of Physiological Chemistry and Pathobiochemistry, University of Münster, Münster, Germany;7. Department of Medicine, University of Oviedo, Oviedo, Spain;1. Department of Immunohematology & Blood Transfusion, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India;2. Department of General Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India;3. Department of Transfusion Medicine, Apollo Main Hospital, Greams Road, Chennai, Tamil Nadu, India;1. Department of Transfusion Medicine, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai 410210, India;1. Department of Internal Medicine, Division of Hematology, Cedars-Sinai Medical Center, Los Angeles, USA;2. Department of Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, USA;3. Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, USA;4. Cedars-Sinai Medical Center, Los Angeles, USA;5. Department of Pathology, Division of Transfusion Medicine, Cedars-Sinai Medical Center, Los Angeles, USA;6. Department of Medicine, Division of Infectious Diseases, Cedars-Sinai Medical Center, Los Angeles, USA;7. Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, USA;8. Department of Pathology, Division of Transfusion Medicine, Johns Hopkins University School of Medicine, Baltimore, USA;9. Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA;1. Galilee Medical Center, 22100 Nahariya, Israel;2. Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel;1. Galilee Medical Center, 22100 Nahariya, Israel;2. Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel |
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| Abstract: | BackgroundTherapeutic plasma exchange (TPE) is an extracorporeal treatment that can be used in adult and pediatric patients with acute demyelinating syndromes of the central nervous system. In this study, the efficacy and safety of TPE was evaluated in 10 pediatric patients who underwent TPE that were unresponsive to corticosteroid treatment.MethodsRecords of 10 pediatric patients who underwent TPE in our pediatric intensive care unit (PICU) between May 2017 and June 2020 were used. Expanded Disability Status Scale (EDSS), Gait Scale (GS), and Visual Outcome Scale (VOS) were applied to the patients before and after TPE.ResultsOf the 10 patients who underwent TPE, five were diagnosed with multiple sclerosis (MS), three with transverse myelitis (TM), and two with acute disseminated encephalomyelitis (ADEM). The median age of the patients was 13.3 years (IQR 8-15), and the median day from symptom onset to onset of TPE was 12.5 days (IQR 7-28). A total of 104 TPE sessions were performed successfully. While no complications were encountered in three patients during the sessions, the most common complication was hypofibrinogenemia. The decrease in EDSS and GS scores was found to be consistent with the clinical response of the patients. There was no statistically significant decrease in the VOS.ConclusionsWith this study, we can say that TPE is a feasible, effective, and safe treatment modality in children with acute demyelinating syndromes of the central nervous system. |
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| Keywords: | acute demyelinating syndromes children Therapeutic plasma exchange |
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