A recent case series from Japan published in the Journal of Clinical Apheresis found that centrifugal therapeutic plasma exchange (TPE), a strategy used in severe fetal and neonatal alloimmune thrombocytopenia (FNAIT), is safe and has high completion rates.
Of the patients undergoing centrifugal TPE without extracorporeal membrane oxygenation (ECMO) support, 100% of sessions were completed. Furthermore, no serious bleeding events or instances of low blood pressure needing intervention occurred.
Two primary methods of TPE exist today: membrane filtration and centrifugation. While centrifugal TPE predominates in Western nations including the United States, membrane filtration is much more common in Japan. Centrifugation is becoming more common in Japan, particularly in adult populations, but real-world data in pediatric populations remains limited.
The study included 19 participants with a median age of six years at the first session. Reasons for needing TPE varied, from immune-related neurological conditions to systemic inflammation. Patients underwent a total of 95 sessions, with each individual undergoing a median of five sessions.
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Of the 84 sessions not involving extracorporeal membrane oxygenation support, 15.5% of cases required vascular access reinsertion. However, all sessions proceeded until completion afterwards.
In addition, two individuals experienced mild allergic reactions, both of which involved the use of fresh frozen plasma rather than albumin. These patients received antihistamines and temporarily had their infusion rate reduced. Again, though, both sessions were completed successfully.
Participants experienced decreases in levels of immunoglobulin G, fibrinogen, platelets and ionized calcium. No individuals required platelet transfusions, and no bleeding events associated with thrombocytopenia were noted.
Although none of the patients in this sample had a diagnosis of FNAIT, these results support the use of TPE in younger patients, which may translate into practice for individuals affected by FNAIT.
“Collectively, these findings provide practical, Japan-specific implementation data to inform protocol development and clinical decision-making for pediatric [centrifugal TPE], particularly in centers where membrane-based approaches have traditionally predominated,” the authors concluded.
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