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Therapeutic Apheresis in the Pediatric Intensive Care Unit

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Pediatric Critical Care Medicine

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Abstract

In its most general sense, apheresis refers to techniques for large-scale removal of selected components of the blood. “Plasmapheresis” refers to removal of plasma, “erythrocytapheresis” to removal of red blood cells, and “leukapheresis” to removal of white blood cells. The provision of apheresis for critically ill children is becoming more commonplace as the immunobiology of various acute diseases is becoming elucidated, yet remains challenging due to a number of un-modifiable factors. However, given the relative infrequency of these disorders, prospective randomized trials to evaluate the efficacy of therapeutic apheresis are lacking. In addition, critically ill children develop their maximal organ failures and mortality very early in the intensive care unit time course, so waiting to see if a disease will resolve is often not a clinical option for many of these patients. Finally, many diseases do not have a biological marker to follow, so reliance on clinical improvement can be very subjective. The aim of this chapter is to describe the technical pediatric specific considerations and typical indications for apheresis provision for children seen in the pediatric intensive care unit setting. In addition, a framework for consideration of when to initiate, continue and discontinue therapeutic plasmapheresis is provided.

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Authors and Affiliations

  1. Department of Pediatrics, Center for Acute Care Nephrology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA

    Stuart L. Goldstein MD

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  1. Stuart L. Goldstein MD
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Correspondence to Stuart L. Goldstein MD .

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Editors and Affiliations

  1. Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

    Derek S. Wheeler

  2. Div. of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

    Hector R. Wong

  3. MICHR, University of Michigan Medical Scho, Ann Arbor, Michigan, USA

    Thomas P. Shanley

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Goldstein, S.L. (2014). Therapeutic Apheresis in the Pediatric Intensive Care Unit. In: Wheeler, D., Wong, H., Shanley, T. (eds) Pediatric Critical Care Medicine. Springer, London. https://doi.org/10.1007/978-1-4471-6416-6_22

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  • DOI: https://doi.org/10.1007/978-1-4471-6416-6_22

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