Esin Aydın AKSOY, Selman KESİCİ, Şule Ünal CANGÜL, Salih AKSU, Benan BAYRAKÇI
Journal of Academic Research in Medicine - 2026;16(2):106-112
Objective: Therapeutic plasma exchange (TPE) is an apheresis procedure in which the patient's plasma is removed and replaced with replacement fluid. We report an 11-year single-center experience with pediatric TPE in a pediatric intensive care unit (PICU). Methods: This retrospective, single-center, observational study included 51 pediatric patients who underwent 248 TPE procedures in the PICU over an 11-year period. The indications for TPE were grouped as follows: 1. microangiopathic hemolytic anemia, including sepsis, disseminated intravascular coagulation (DIC), thrombocytopenia-associated multiorgan failure (TAMOF), hemolytic uremic syndrome (HUS), and hepatitis; 2. hemophagocytic lymphohistiocytosis (HLH) or macrophage activation syndrome (MAS); 3. intoxications; 4. neurological diseases. The clinical and laboratory data of these patients, including organ failure and scores on the pediatric logistic organ dysfunction (PELOD) and Glasgow coma scale, were recorded. Results: The time for TPE after admission to PICU was 2.2+/-5.1 days. Twenty-eight (54.9%) patients were discharged, and 23 (45.1%) died. Minor complications that can be attributed to TPE were observed in 14.9% of the patients. Earlier initiation of TPE appeared to be associated with more favorable outcomes. A significant increase in platelet count was observed in Group 1, and favorable responses were also noted in selected intoxication cases. In contrast, no clear additional benefit was demonstrated in the HLH/MAS group. Conclusion: TPE may be considered an option in pediatric patients with sepsis, DIC, TAMOF, HUS, and hepatitis (Group 1), as well as in selected intoxication cases. In Group 1, improvements in platelet counts and PELOD scores were the principal responses to treatment.
