Role of therapeutic plasma exchange in management of hemolysis associated with extracorporeal membrane oxygenation in neonates with congenital diaphragmatic hernia: A case series

Nicole Cimbak , Farokh R. Demehri , Jill M. Zalieckas , Belinda Hsi Dickie
{"title":"Role of therapeutic plasma exchange in management of hemolysis associated with extracorporeal membrane oxygenation in neonates with congenital diaphragmatic hernia: A case series","authors":"Nicole Cimbak ,&nbsp;Farokh R. Demehri ,&nbsp;Jill M. Zalieckas ,&nbsp;Belinda Hsi Dickie","doi":"10.1016/j.epsc.2024.102869","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><p>Plasma free hemoglobin (PFH) is a product of intravascular hemolysis associated with certain disease states as well as the shearing effects of mechanical support devices, such as extracorporeal membrane oxygenation (ECMO). There are detrimental effects of intravascular hemolysis secondary to ECMO including severe hyperbilirubinemia, thrombus within the ECMO circuit causing inability to provide adequate support, and as a result, a need for ECMO circuit exchanges. Neonates can experience renal failure, kernicterus, and other significant morbidities as a result of hemolysis secondary to ECMO.</p></div><div><h3>Case series</h3><p>We present three cases of neonates with a gestational age of 35–37 weeks who had a left-sided CDH and were cannulated to VA-ECMO on the first day of life using an 8 French arterial cannula and a 10 French venous cannula. Within the first 10 days of the ECMO run all patients developed markedly elevated PFH of (peaks of 465, &gt;500 and &gt; 500 mg/dL), and creatinine, and underwent therapeutic plasma exchange (TPE). TPE was done using frozen fresh plasma (FFP) replacement in line with the ECMO circuit. All patients showed a remarkable decrease in the PFH levels after the TPE treatment. The number of TPE rounds ranged from 1 to 6, depending on the evolution of the PFH levels. One patient developed hypocalcemia that resulted in decreased cardiac pulsatility during the first round of TPE that resolved with aggressive calcium repletion. The total duration of the ECMO runs ranged from 16 to 29 days. None of the patients required continuous renal replacement therapy. All patients were discharged home at ages ranging from 2 to 6 months.</p></div><div><h3>Conclusion</h3><p>Mechanical cell hemolysis is a significant source of morbidity in neonatal patients on ECMO. This case series exemplifies a safe and impactful intervention to address hemolysis in a critically ill patient population.</p></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"110 ","pages":"Article 102869"},"PeriodicalIF":0.2000,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2213576624000976/pdfft?md5=17ad7bec9b19333d66b6736432f7f0b8&pid=1-s2.0-S2213576624000976-main.pdf","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Pediatric Surgery Case Reports","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2213576624000976","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"PEDIATRICS","Score":null,"Total":0}
引用次数: 0

Abstract

Introduction

Plasma free hemoglobin (PFH) is a product of intravascular hemolysis associated with certain disease states as well as the shearing effects of mechanical support devices, such as extracorporeal membrane oxygenation (ECMO). There are detrimental effects of intravascular hemolysis secondary to ECMO including severe hyperbilirubinemia, thrombus within the ECMO circuit causing inability to provide adequate support, and as a result, a need for ECMO circuit exchanges. Neonates can experience renal failure, kernicterus, and other significant morbidities as a result of hemolysis secondary to ECMO.

Case series

We present three cases of neonates with a gestational age of 35–37 weeks who had a left-sided CDH and were cannulated to VA-ECMO on the first day of life using an 8 French arterial cannula and a 10 French venous cannula. Within the first 10 days of the ECMO run all patients developed markedly elevated PFH of (peaks of 465, >500 and > 500 mg/dL), and creatinine, and underwent therapeutic plasma exchange (TPE). TPE was done using frozen fresh plasma (FFP) replacement in line with the ECMO circuit. All patients showed a remarkable decrease in the PFH levels after the TPE treatment. The number of TPE rounds ranged from 1 to 6, depending on the evolution of the PFH levels. One patient developed hypocalcemia that resulted in decreased cardiac pulsatility during the first round of TPE that resolved with aggressive calcium repletion. The total duration of the ECMO runs ranged from 16 to 29 days. None of the patients required continuous renal replacement therapy. All patients were discharged home at ages ranging from 2 to 6 months.

Conclusion

Mechanical cell hemolysis is a significant source of morbidity in neonatal patients on ECMO. This case series exemplifies a safe and impactful intervention to address hemolysis in a critically ill patient population.

查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
治疗性血浆置换在处理先天性膈疝新生儿体外膜氧合相关溶血中的作用:病例系列
导言血浆游离血红蛋白(PFH)是与某些疾病状态以及体外膜肺氧合(ECMO)等机械支持设备的剪切效应相关的血管内溶血的产物。继发于 ECMO 的血管内溶血会产生有害影响,包括严重的高胆红素血症、ECMO 循环内的血栓导致无法提供足够的支持,因此需要更换 ECMO 循环。我们介绍了三例胎龄为 35-37 周的新生儿,他们患有左侧 CDH,出生后第一天就使用 8 法分动脉插管和 10 法分静脉插管进行 VA-ECMO 插管。在 ECMO 运行的前 10 天内,所有患者都出现了 PFH 和肌酐明显升高(峰值分别为 465、500 和 500 mg/dL),并接受了治疗性血浆置换(TPE)。治疗性血浆置换采用与 ECMO 循环一致的冷冻新鲜血浆(FFP)置换。经过 TPE 治疗后,所有患者的 PFH 水平都明显下降。根据 PFH 水平的变化,TPE 治疗的次数从 1 次到 6 次不等。一名患者在第一轮 TPE 期间出现低钙血症,导致心脏搏动性下降,但在积极补钙后缓解。ECMO 运行的总时间从 16 天到 29 天不等。没有一名患者需要持续接受肾脏替代治疗。结论机械性细胞溶血是新生儿 ECMO 患者发病的一个重要原因。本系列病例是解决重症患者溶血问题的安全、有效干预措施的典范。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 去求助
来源期刊
CiteScore
0.60
自引率
25.00%
发文量
348
审稿时长
15 days
期刊最新文献
Spontaneous enterocutaneous fistula in a neonate: A case report Inflammatory myofibroblastic tumor of the sigmoid colon: A case report 3D-printed model for surgical planning in congenital porto-systemic shunt: A case report Rapidly progressing necrotizing fasciitis with chickenpox infection: A case series Spigelian hernia diagnosed in a newborn: A case report
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1