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Abstract: PO1959

Clinical Evaluation of Membrane Therapeutic Plasma Exchange Using Prismaflex Machines and Fresh Frozen Plasma in Pediatric Patients

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology


  • Shah, Siddharth A., University of Louisville, Louisville, Kentucky, United States

Previous studies have shown that membrane-based therapeutic plasma exchange (m-TPE) can be an effective method. The availability of a TPE 2000 filter membrane set with Prismaflex machines provides added advantage to perform TPE along with continuous renal replacement therapy (CRRT). The extracorporeal volume of this filter at 125 ml is lower than centrifugation-based apheresis systems. There is very little data on the efficacy and complications of this procedure in small children. Fresh frozen plasma (FFP) has a high citrate content (20 mmol/L). There may be the risk of significant hypocalcemia using FFP as replacements.


We performed a retrospective analysis of children who underwent m-TPE using the TPE 2000 filter membrane set with Prismaflex machines at our center during last year. We included children who required heparin, or bivalirudin as anticoagulation, and FFP as replacements. Given the minimum blood flow requirements of 100 ml/min, we only performed this procedure with children < 10 kg who were on ECMO. To prevent hypocalcemia, we administered calcium chloride drip with starting dose of 20 mg/kg/hour before initiation of TPE. We adjusted the calcium chloride drip based on the ionized calcium monitoring scale. Additional calcium boluses were given for hypocalcemia persisting after drip adjustment to a maximal rate of 50 mg/kg/hr.


We included eight children in the analysis who required both CRRT and TPE. The age range was 23 days-15 years (median: 2 years). On average, we performed 3.1 treatments per patient with a mean treatment time of 175 minutes. In 2/8 patients, bivalirudin was used. Common complications included hypocalcemia requiring additional calcium bolus (2/8), high transmembrane pressure (TMP) (1/8), and hemodynamic instability (1/8). There was no significant correlation between age and dose of calcium drip required (p-value: 0.433); and ECMO and requirement of additional calcium boluses (p-value: 0.107). There was a significant improvement in inflammatory markers (D-dimer, CRP, IL6) and bilirubin level post-pheresis treatment.


The TPE procedure using Prismaflex may be a practical option for children undergoing CRRT, but further studies are required to assess its use in children with weights less than 20 kg. Most children tolerated the procedure well in our study. Hypocalcemia is a critical complication with this procedure.