Complications of Therapeutic Plasma Exchange: A Retrospective Study of 1201 Procedures in 435 Children

Objective: Therapeutic plasma exchange (TPE) is an extracorporeal procedure that consists of removing the patient`s plasma and replacing it with an appropriate replacement fluid. This study aimed to evaluate the complications of TPE in children.

Methods: A retrospective cohort of hospitalized children treated with TPE in West China Second University Hospital, Sichuan University, between January 2013 and July 2018 were enrolled.

Results: A total of 1201 TPE procedures were completed in 435 children. Complications occurred in 152 procedures (12.7%); 90 procedures (7.5%) had two or more complications. No death occurred. The most common complication was pruritus and urticaria (7%), followed by hypertension (1.92%) and hypotension (1.17%). One child had an outbreak infection of disseminated cryptococcosis neoformans, one went into anaphylactic shock, and three had Steven-Johnson syndrome. The incidence of pruritus and urticaria was higher among children in the 6~15-year-old group and the 30~67 kg group (P<0.05). There was no significant difference in the incidence of hypertension and hypotension among children at different ages and weights (P>0.05). Compared with other diseases, anti-N-methyl-D-aspartate (anti-NMDA) receptor encephalitis led to a higher incidence of complications in children (P<0.05).

Conclusions: The results suggest that TPE is a relatively safe procedure for children, and most of the complications of this procedure are mild. The most common complication is pruritus and urticaria. However, preventing serious complications, such as toxic epidermal necrolysis and infection, is still necessary.