Plasma exchange using a continuous venovenous hemofiltration machine in children.
BACKGROUND
There is considerable interest in using continuous venovenous hemofiltration machines for plasma exchange therapy in children.


METHODS
Retrospective study of 7 patients and 61 plasma exchange treatments using the Baxter/Edwards Lifesciences BM25 machine with commercially available plasma filters (mostly Asahi Plasmaflo).


RESULTS
The average total exchange volume was 1.5 times the plasma volume, achieved at a blood flow rate of 100 ml/m(2) (3.5 ml/kg/min) and a turnover rate of 25 ml/kg/h over a 3-hour duration. Fifty-six percent of the time, a mean heparin bolus of 29 units/kg resulted in subtherapeutic activated clotting times. Mean heparin infusion rates of 35 units of heparin/kg/h achieved effective anticoagulation. A calcium infusion rate of 0.11 +/- 0.05 mmol/kg/h avoided hypocalcemia. One patient experienced the serious complication of membrane reaction.


CONCLUSIONS
This setup provides a safe approach to plasma exchange in children. A similar method could be implemented in other centers.
Ciechanska
Ewa
E
Department of Pediatrics, Division of Nephrology, Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada.
Segal
Lauren
L
Wong
Hubert
H
Chretien
Christine
C
Feber
Janusz
J
Filler
Guido
G
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006440:Hemofiltration / Q000295:instrumentation / Q000379:methods; D006801:Humans; D008297:Male; D010865:Pilot Projects; D010951:Plasma Exchange / Q000295:instrumentation / Q000379:methods; D012189:Retrospective Studies