Prognostic indicators of improvement with therapeutic plasma exchange in pediatric demyelination.

Objectives: To determine the safety and clinical benefit of therapeutic plasma exchange (TPE) as rescue therapy in children with acute inflammatory demyelinating CNS syndromes and to identify baseline prognostic indicators of treatment improvement.

Methods: This single-center retrospective pediatric cohort included all consecutive patients admitted to our hospital over the period from 2003 to 2017 because of a steroid-refractory acute CNS event presumed to be inflammatory who required TPE. Functional status assessment to identify improvement included the following performance category scales: visual outcome, bladder control, gait, and Expanded Disability Status Scale (EDSS).

Development of apheresis techniques and equipment designed for patients weighing less than 10 kg.

The procedure of apheresis in pediatric patients, particularly in those with low weight (body weight<10 kg) presents an important challenge due to particularities of this group. There are no specific guidelines or enough scientific evidence to standardize the practice in this group of patients. In addition to the psychological aspect, the correct calculation of the total blood volume, the extracorporeal volume of the cell separator and an estimated decrease in hematocrit must be considered.