Developing a Protocol for Therapeutic Plasma Exchange in Tandem With Continuous Renal Replacement Therapy (CRRT) and ExtraCorporeal Membrane Oxygenation (ECMO) in Pediatric Patients

Document Type

Journal Article

Publication Date

8-1-2025

Journal

Journal of clinical apheresis

Volume

40

Issue

4

DOI

10.1002/jca.70051

Keywords

continuous renal replacement therapy; extracorporeal circuit membrane oxygenation; pediatric transfusion; therapeutic plasma exchange

Abstract

Therapeutic plasma exchange (TPE) in pediatric patients presents many challenges, including management of a large extracorporeal volume (ECV) and calcium replacement for patients who may not be able to express signs of hypocalcemia or other associated adverse events with a large ECV. Pediatric patients who are critically ill on continuous renal replacement therapy (CRRT) and/or extracorporeal membrane oxygenation (ECMO) may have indications for TPE, such as sepsis or liver failure anticipating transplant. It may be difficult or clinically detrimental to take the patient off the CRRT or ECMO circuit to perform TPE. Connecting the TPE device into the preexisting circuit is feasible with the understanding of the principles of the circuit flow set up and monitoring to mitigate adverse events. Effective communication among clinical teams managing distinct extracorporeal circuits is critical to ensuring coordinated patient care.

Department

Pathology

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