Pediatric blood purification therapy in our hospital and countermeasures taken to improve safety

Abstract

We treated 30 pediatric cases aged ＜15 years over the 10-year period from January 2003 through December 2012 for whom we devised countermeasures to safely conduct pediatric blood purification therapy. These countermeasures involved minimizing fluctuations in hemodynamics by initiating treatment after washing blood in the continuous hemodialysis (CHD) mode while transfusing blood and using albumin in the transfusion solution during the acute phase. In cases requiring plasma exchange(PE), PE ＋ continuous renal replacement therapy (CRRT) with the series–parallel method was used to correct electrolyte imbalances such as hypocalcemia caused by fresh frozen plasma (FFP) transfusion. Removal of impurities was also simplified by applying a series–parallel dedicated circuit. Incorporating a CRRT circuit into an extracorporeal membrane oxygenation (ECMO) circuit in cases requiring ECMO was useful for those in which vascular access was difficult. Pediatric blood purification therapy must be conducted safely using various measures that take into account the peculiarities of pediatric blood purification such as the ratio of circulating blood volume to the amount of filling solution and securing of vascular access.