title: Intensive plasma exchange for severe autoimmune hemolytic anemia in a four-month-old infant.
abstract: We report the smallest infant (7.5 kg) to receive intensive plasma exchange (52 PEs) therapy as treatment of autoimmune hemolytic anemia (AIHA). PE temporarily reduces circulating autoantibody levels and can be an effective adjunctive therapy with corticosteroids and cytotoxic drugs or other immuno-suppressants. Although his clinical course was prolonged and complicated by cytomegalovirus infection with spontaneous perforation of his colon, his recovery was complete. He has remained healthy for more than 2 years. Because of his small size, calcium gluconate was added to replacement fluids and calcium levels closely monitored. The apheresis machine and tubing were routinely primed with red blood cells and FFP substituted for 5% human albumin during the second half of all procedures to maintain adequate levels of procoagulant. Our experience suggests that intensive PE is helpful in controlling severe AIHA and should be considered even for very small patients.
authors.affiliation: Indiana University Medical Center, Indianapolis, Indiana 46202, USA. lmmcarth@iupui.edu
authors.forename: L J
authors.initials: LJ
authors.lastname: McCarthy
authors.forename: C F
authors.initials: CF
authors.lastname: Danielson
authors.forename: C
authors.initials: C
authors.lastname: Fernandez
authors.forename: E
authors.initials: E
authors.lastname: Skipworth
authors.forename: C A
authors.initials: CA
authors.lastname: Limiac
authors.forename: T
authors.initials: T
authors.lastname: Prahlow
authors.forename: J
authors.initials: J
authors.lastname: Goldman
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000744:Anemia, Hemolytic, Autoimmune / Q000150:complications / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D001327:Autoimmune Diseases / Q000150:complications / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D002125:Calcium Gluconate / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003586:Cytomegalovirus Infections / Q000150:complications; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D007223:Infant; D007416:Intestinal Perforation / Q000150:complications; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D010951:Plasma Exchange; D012810:Sigmoid Diseases / Q000150:complications; D013156:Splenectomy
chemical_list: D000305:Adrenal Cortex Hormones; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D002125:Calcium Gluconate; D008775:Methylprednisolone