Plasma Exchange: An Important Part of the Therapeutic Procedure in a Small Child with Autoimmune Hemolytic Anemia

Abstract

The case history of a child with autoimmune hemolytic anemia with complement activating warm antibodies of the pdl type is presented. This child also had giant cell hepatitis. Although plasma exchange is not curative in such a patient, the removal of antibodies and bilirubin by means of plasma exchange has alleviated the patient's condition on two occasions (at age 19 and 33 months respectively), and has permitted the institution of effective immunosuppression. A technique for plasma exchange is described, which by use of plasma filters and the usual hemodialysis equipment allows to safely perform the procedure in any pediatric hemodialysis unit. Its use in this patient stresses the technical practicability even in very young children. It is suggested that plasma exchange, if indicated, should be considered more often as part of a therapeutic concept.

Successful liver transplantation for giant cell hepatitis and Coombs‐positive hemolytic anemia: A case report

“…The hemolytic anemia is controlled after the initial episode. In a few children with persistent hemolysis, plasmapheresis and splenectomy have been reported to be beneficial (20, 21). Some patients underwent OLT after a trial of immunosuppressive therapy; but information about the effect of OLT in these patients is scant.…”

Intensive plasma exchange for severe autoimmune hemolytic anemia in a four-month-old infant

“…Plasma exchange (PE) removes autoantibodies from patients with severe autoimmune hemolytic anemia (AIHA) and allows time for more conventional therapies to become effective [8,2,1]. AIHA has been associated with significant mortality in children; 10% to 28% [4,7,23,3].…”

Giant cell hepatitis with Coombs‐positive haemolytic anaemia: steroid sparing with high‐dose intravenous immunoglobulin and cyclosporine

“…In four patients, IVIg have been used to treat AIHA, before the development of liver disease ; other five patients received IVIg as a second line treatment, after liver disease relapse or liver transplant . In only three patients, monthly infusion has been reported : two patients received IVIg as a second line therapy, in association with rituximab and after liver transplant , one patient received IVIg from the beginning of treatment in association with plasmaapheresis . IVIg act at different levels in the immune response machinery, displaying different immunomodulatory effects which can explain the wide spectrum of autoimmune and systemic inflammatory conditions that have reportedly responded to this therapy .…”