Abstract: FR-PO0927
Tandem Therapeutic Plasma Exchange and CKRT in a Neonate: Technical Considerations and Preventive Strategies
Session Information
- Pediatric Nephrology: Genetic Diseases, Development, Neonatal Nephrology, Glomerular Diseases, and More
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pediatric Nephrology
- 1800 Pediatric Nephrology
Authors
- Fradkin, Mark, Akron Children's Hospital, Akron, Ohio, United States
- Raina, Rupesh, Akron Children's Hospital, Akron, Ohio, United States
- Fuhrman, Dana Y., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Moritz, Michael L., Akron Children's Hospital, Akron, Ohio, United States
Introduction
Therapeutic plasma exchange (PLEX) is rarely performed in neonates because of technical challenges and device size limitations. No commercially available extracorporeal devices are specifically labeled for infant use. Reports describing tandem PLEX-CKRT in neonates are lacking. We describe successful tandem PLEX-CKRT in a neonate and the measures used to prevent complications.
Case Description
A 10-day-old, 3-kg neonate on CKRT for multiple organ dysfunction syndrome (MODS) due to severely depressed biventricular function underwent tandem PLEX for suspected thrombocytopenia-associated multi-organ failure (TAMOF). Heparin anticoagulation was used because of a prior citrate lock. The combined PLEX-CKRT circuit volume was 293 mL, exceeding the patient’s estimated blood volume of 250 mL. Precautions were taken to address complications from the large unphysiologic blood prime: 1) priming with PRBCs reconstituted to a Hct of 40% to prevent polycythemia; 2) an additional 20 units/kg heparin bolus to prevent circuit clotting; 3) warming to prevent hypothermia; 4) epinephrine to support circulation; 5) a calcium bolus to prevent hypocalcemia; 6) sodium bicarbonate to correct acidosis; and 7) high CKRT clearance (3000 mL/hr/1.73 m2) during the first 30 minutes of PLEX to prevent hyperkalemia. The patient tolerated three daily tandem PLEX-CKRT treatments without complication. PLEX was discontinued because the platelet count did not improve. MODS resolved, and CKRT was discontinued.
Discussion
Tandem PLEX-CKRT can be successfully performed in a neonate despite a large extracorporeal circuit volume by anticipating potential complications and implementing preventive measures.
Tandem CKRT-PLEX Circuit Configuration