title: Frequency of hemorrhagic complications in plasmapheresis without extracorporeal circuit anticoagulation, in children.
abstract: BACKGROUND
  The current practice of plasmapheresis at most centers employs anticoagulation of the extracorporeal circuit, which has been associated with complications. There are few studies evaluating the efficacy and safety of using plasmapheresis without any anticoagulation. We report our experience using this strategy in children (1 month to 18 years old) over a period of 5 years.
  
  
  RESULTS
  Two hundred forty-three plasmapheresis sessions without anticoagulation of the extracorporeal circuit, in 27 pediatric patients, were analyzed. Of these, 81.4% were female and the predominant age range was 12-18 years (70.3%). One hundred percent of the patients had PRISM III scale low mortality risk, and the main indication of therapy was acute rejection after renal transplantation (25.9%), followed by recurrence of focal segmental sclerosis in the transplanted kidney (17.2%). Filtration lasted more than 3 hours in 86.8% of cases, with bleeding complications in 2.9% of patients requiring early termination due to associated complications in 3.2% of cases. Other complications were paresthesias (0.41%), vomiting (5%), hypertension during (67.4%) and after therapy (64.6%), and hyperchloremia (46.5%).
  
  
  CONCLUSIONS
  In our experience, plasmapheresis without circuit anticoagulation in children is safe and effective, with a low frequency of bleeding and hydroelectrolytic complications, allowing the achievement of therapeutic goals without altering therapy duration and efficiency. Prospective studies are needed to corroborate these findings.
authors.affiliation: Fundación Cardioinfantil, Bogotá, Colombia; Pediatric Intensive Care Specialization Program Director at the Universidad de la Sabana, Colombia. Electronic address: jfernandezsarmiento@yahoo.com.mx.
authors.forename: Jaime
authors.initials: J
authors.lastname: Fernández Sarmiento
authors.affiliation: Universidad de la Sabana, Fundación Cardioinfantil, Bogotá, D.C, Colombia. Electronic address: alejitav1982@hotmail.com.
authors.forename: María A
authors.initials: MA
authors.lastname: Varela
authors.affiliation: Magister en epidemiología clínica, Doctor en sistemas de salud, Grupo de investigación en salud, Universidad de la Sabana, Colombia.
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Pinzón
mesh_terms: D000293:Adolescent; D002648:Child; D005112:Extracorporeal Circulation / Q000009:adverse effects*; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D008297:Male; D010956:Plasmapheresis / Q000009:adverse effects*
keywords: Anticoagulation; Apheresis; Plasmapheresis; Therapeutic plasma exchange