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Experiences with plasmapheresis in our pediatric dialysis unit

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)

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Experiences with plasmapheresis in our pediatric dialysis unit

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  1. 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

  2. Introduction • Extracorporeal therapy • Therapeutic Plasma Exchange (TPE) • Replacement fluid • Fresh frozen plasma • Albumin

  3. Introduction • Vascular access • Anticoagulation • Adapted machinery • Blood priming

  4. Introduction • Removal of (auto)antibodies, immune complexes • Intoxication (protein bound) • Removal of protein bound medication • Hyper viscosity (Para proteins) • > 15000 Dalton

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

  6. Methods

  7. 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

  8. Patients • N=16 • Age 4 months- 18 years • Weight 7-67 kg

  9. 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)

  10. Results • Positive effect Atypical HUS Myasthenia Gravis Wegeners granulomatosis Recurrent NS after transplantation (n=2)

  11. Results • No effect Anti-GBM nephritis Progressive necrotizing encephalopathy

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

  13. Complications • Allergic reactions • Hypocalcaemia • Hypotension • Access problems • Catheter related problems Infection Clotting

  14. 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

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