experiences with plasmapheresis in our pediatric dialysis unit
DESCRIPTION
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) - PowerPoint PPT PresentationTRANSCRIPT
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
• 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
• 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)
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