Intensive blood and plasma exchange for treatment of coagulopathy in meningococcemia

✍ Scribed by Kevin B. Churchwell; Michael L. McManus; Patricia Kent; Jed Gorlin; Dolores Galacki; Donald Humphreys; Sherwin V. Kevy

• Publisher: John Wiley and Sons
• Year: 1995
• Tongue: English
• Weight: 641 KB
• Volume: 10
• Category: Article
• ISSN: 0733-2459
• DOI: 10.1002/jca.2920100403

✦ Synopsis

Eight pediatric patients with fulminant meningococcemia, purpura, and disseminated intravascular coagulation who by multiple prognostic scoring systems were anticipated to have a poor outcome underwent intensive plasma exchange (IPE) or whole blood exchange (WBE) in addition to standard medical therapy. IPE/WBE was initiated shortly after admission with a mixture of both fresh frozen plasma and cryoprecipitate as the replacement solution. All IPE procedures were performed using a continuous flow system and a red cell prime. The mean fibrinogen level increased from 62 to 192 mg/dl, the prothrombin time (FT) decreased from a mean of 32.4 seconds to 15.1 seconds, and the mean activated partial thromboplastin time (APTT) decreased from 89.5 seconds to 40.1 seconds following completion of the initial IPE/WBE. There was a corresponding improvement in all coagulation factor levels but only slight improvement in antithrombin I11 (ATIII) and protein C levels. Seven of eight patients survived (87.5%) their initial presentation with the sole early death attributed to meningitis with cerebral edema. Mean fluid balance after the procedure was + 10.8 I 5.87 cclkg. There were no significant bleeding or cardiovascular complications during the procedure. There was no clinical or radiographic evidence of fluid overload after the procedure.

This experience demonstrates that IPE/WBE may be conducted safely in critically ill, unstable pediatric patients and is effective in rapidly improving coagulopathy without fluid overload.