Plasmapheresis and Total Plasma Exchange in the PICU

  • Stuart L. GoldsteinEmail author


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 is challenging due to a number of unmodifiable 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. 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.


Plasmapheresis Plasma exchange Children 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Center for Acute Care Nephrology, Cincinnati Children’s Hospital Medical CenterCincinnatiUSA
  2. 2.Pheresis Service, Cincinnati Children’s Hospital Medical CenterCincinnatiUSA

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