The Role of Therapeutic Plasma Exchange (TPE) in Multisystem Inflammatory Syndrome in Children (MIS-C)

Abstract

Multisystemic inflammatory syndrome in children (MIS-C) is a new potentially life-threatening disease that is related to coronavirus disease 2019 (COVID-19). The aim of this study is to reveal the clinical and laboratory results of MIS-C and the role of therapeutic plasma exchange (TPE) in its treatment. Clinical, laboratory and radiological characteristics of the patients who were admitted to the pediatric ward and pediatric intensive care unit (PICU) of a tertiary hospital with a diagnosis of MIS-C between April 2020 and March 2021 were included in the study. Forty-one patients were admitted to our hospital with a diagnosis of MIS-C. Twenty-one (51.2%) patients were admitted to the PICU. Six patients needed invasive mechanical ventilation (14.6%), 10 patients (24.4%) TPE and 3 patients (7.3%) needed extracorporeal membrane oxygenation (ECMO). The patients were grouped according to need for PICU admission (Group 1: no need for PICU, Group 2: need for PICU admission). Group 2 had significantly higher levels of C-reactive protein (CRP), alanine aminotransferase (ALT), ferritin, D-dimer, pro-B type natriuretic peptide (pro BNP) and lactate (p < 0.05). Hyponatremia found to be an independent risk factor for inpatient MIS-C in the PICU. We think that dynamic laboratory trending is beneficial in determining the need for PICU admission and TPE may be effective in critically ill patients.

Plasmapheresis as therapeutic option in a 16-year-old with EVALI

“…13 The mainstays in the therapy for PIMS are immunomodulation (glucocorticoids, immunoglobulins, Anakinra) and anticoagulant therapy. 14,15 In severe cases of suspected EVALI, the principles of treatment are similar.…”

“…21 TPE has also been successfully used for the treatment of inflammatory syndromes after SARS-CoV-2-infections in adults and children. 14,22 As a result, many authors consider TPE to be the last therapeutic resort when standard (immunomodulatory) therapy fails. The use of TPE in EVALI has not been reported to our knowledge and more study is certainly necessary.…”

“…The basic aim of TPE is to eliminate cytokines, inflammatory proteins and pathological antibodies to reduce the complications and organ damage caused by a massive inflammatory mediated immune response. Therefore, TPE is one of the therapies suggested for PIMS or severe SARS-CoV-2 infections when other therapeutic options fail 14,20 . The results of a meta-analysis indicated that TPE can reduce mortality in severe COVID-19 but with no change in ICU length of stay 21 .…”

“…The results of a meta-analysis indicated that TPE can reduce mortality in severe COVID-19 but with no change in ICU length of stay 21 . TPE has also been successfully used for the treatment of inflammatory syndromes after SARS-CoV-2-infections in adults and children 14,22 . As a result, many authors consider TPE to be the last therapeutic resort when standard (immunomodulatory) therapy fails.…”

Cardiovascular Outcomes in Children with Multisystem Inflammatory Syndrome Treated with Therapeutic Plasma Exchange

“…Atay et al investigated the role of therapeutic plasma exchange in multisystem inflammatory syndrome in 41 children [ 22 ]. They concluded that therapeutic plasma exchange may be effective in critically ill patients.…”