Abstract
Identify hypocalcemia and hemodynamic disorders related to apheresis in pediatrics either complications in vascular access or related to anticoagulation and adverse reactions with replacement fluid.
Prospective and descriptive study of 171 sessions for therapeutic apheresis in pediatrics during 2018. Inclusion criteria was based on the 2016 Clinical-Practice-of-Therapeutic-Apheresis-guidelines(ASFA). The apheresis technique was selected also based on the 2016 ASFA Guidelines and the expertise in our center.
The 171 sessions were distributed as follows: 73% were immunoadsorption(IA), 12% were cytoapheresis, 10.5% were LDL-apheresis and 4.5% therapeutic plasma exchange(TPE). The average age was 9 years and 58% were women. 50, 33 and 17% were due to Nephrological, Neurological and Digestive pathology respectively. 83% of the nephrological indications correspond to a category I of the ASFA Guidelines, as well as 25% of the neurological indications and all indications of Digestive pathology correspond to a category II. 58, 25 and 17% used temporary catheter, permanent catheter and needles respectively. Only one patient is accidentally removed from the temporary jugular catheter and it has not been related to vascular access or by the apheresis technique itself. Sixty-six percent had individual anticoagulation with citrate/calcium plus heparin and the remaining 33%, only once. Any case of bleeding related to catheter or others. Only 3 sessions of IA in the hypocalcemia objective, being symptomatic in only one of them. Of all 8 sessions of TPE, we performed 6 with frozen fresh plasma as replacement fluid with no adverse reactions.
The apheresis techniques in pediatrics had been presented with few complications in our center, none derived from vascular access, anticoagulation, infections or adverse effects due to use of replacement fluid. The training of medical and nursing staff is essential to identify risk situations. The use of protocols and international guidelines ensure safety in pediatrics.
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