title: Plasma exchange on venovenous extracorporeal membrane oxygenation with bivalirudin anticoagulation.
abstract: A pediatric patient requiring venovenous (VV) extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation developed heparin-induced thrombocytopenia. Unfractionated heparin was discontinued, and a bivalirudin infusion was started. During the lung transplant evaluation, he was found to have allosensitization, requiring treatment with plasma exchange along with pulse methylprednisolone, rituximab, bortezomib, and pooled immunoglobulin infusion. We describe our experience with successful plasma exchange for allosensitization during bivalirudin anticoagulation on VV ECMO in a pediatric patient.
authors.affiliation: Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA Heart Center, Nationwide Children's Hospital, Columbus, OH, USA Department of Cardiovascular Perfusion and ECMO, Nationwide Children's Hospital, Columbus, OH, USA thomas.preston@nationwidechildrens.org.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Preston
authors.affiliation: Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix Children's Hospital, Phoenix, AZ, USA.
authors.forename: Heidi J
authors.initials: HJ
authors.lastname: Dalton
authors.affiliation: Department of Pathology, The Ohio State University College of Medicine, Columbus, OH, USA Department of Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Kathleen K
authors.initials: KK
authors.lastname: Nicol
authors.affiliation: Heart Center, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Brit R
authors.initials: BR
authors.lastname: Ferrall
authors.affiliation: Clinical Pharmacy, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Julie C
authors.initials: JC
authors.lastname: Miller
authors.affiliation: Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Don
authors.initials: D
authors.lastname: Hayes
mesh_terms: D000991:Antithrombins / Q000627:therapeutic use*; D015199:Extracorporeal Membrane Oxygenation; D017809:Fatal Outcome; D006493:Heparin / Q000009:adverse effects; D006629:Hirudins; D006801:Humans; D007223:Infant; D016040:Lung Transplantation; D008297:Male; D010446:Peptide Fragments / Q000627:therapeutic use*; D010951:Plasma Exchange; D011300:Preoperative Care / Q000379:methods*; D011994:Recombinant Proteins / Q000627:therapeutic use; D013921:Thrombocytopenia / Q000139:chemically induced; D013927:Thrombosis / Q000517:prevention & control*
chemical_list: D000991:Antithrombins; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; D006493:Heparin; C074619:bivalirudin
keywords: bivalirudin; extracorporeal membrane oxygenation; plasma exchange; venovenous