Pediatric apheresis presents unique challenges in the care of patients across a broad spectrum of acute and chronic disease. Diminutive blood volumes raise the need for a thoughtful approach to priming the apheresis device. Management of electrolytes in pediatrics is also a challenge. Hypocalcemia is well known but does hypomagnesaemia matter? Concern for bleeding in certain disease states make using heparin a contraindication, but requires a dramatic increase in the citrate ratio. LDL apheresis has proven benefits but requires heparin. These issues become even more complex when addressing these issues while the patient is on ECMO, CRRT or both. This session will discuss priming and anticoagulation options including red cells, reconstituted whole blood, and fresh whole blood for therapeutic apheresis, LDL apheresis (including heparin use and monitoring) and cell therapy applications along with challenges in electrolyte management and variations on fluid replacement for ECMO and CRRT circuits in tandem with therapeutic apheresis.
Contrast saline, albumin, red cells, reconstituted whole blood and fresh whole blood as options for priming an apheresis circuit.
Examine options for anticoagulation in pediatric apheresis.
Discuss electrolyte replacement in pediatric apheresis.
Describe the unique challenges of ECMO and CRRT in tandem with Therapeutic Plasma Exchange.