TY - JOUR
T1 - Successful use of plasma exchange for profound hemolysis in a child with loxoscelism
AU - Said, Ahmed S.
AU - Hmiel, Paul
AU - Goldsmith, Matthew
AU - Dietzen, Dennis
AU - Hartman, Mary E.
N1 - Publisher Copyright:
Copyright © 2014 by the American Academy of Pediatrics.
PY - 2014/11/1
Y1 - 2014/11/1
N2 - We describe a 6-year-old boy who presented with massive hemolysis, shock, disseminated intravascular coagulopathy, and acute renal failure after loxosceles envenomation. In this patient, plasma exchange therapy (PEX) successfully cleared the plasma from an initial hemolytic index of 2000 (equivalent to 2 g/dL hemoglobin, where optimetric laboratory evaluation is impossible) to an index of <50 (no detectable hemolysis). This allowed the PICU team to correct his coagulopathy, assess his degree of organ dysfunction, and provide routine laboratory assessments during continuous venovenous hemodiafiltration. After 9 single volume PEX sessions, his hemolysis and coagulopathy had resolved and his plasma had cleared sufficiently to permit routine laboratory assessments without difficulty. Multiorgan system support with an aggressive transfusion strategy, mechanical ventilation, inotropes, and continuous venovenous hemodiafiltration resulted in complete recovery. We conclude that in the presence of overwhelming hemolysis, plasma can become so icteric that optimetric laboratory evaluation is impossible. In this setting, PEX can be used to clear the plasma, restoring the ability to perform routine laboratory assessments.
AB - We describe a 6-year-old boy who presented with massive hemolysis, shock, disseminated intravascular coagulopathy, and acute renal failure after loxosceles envenomation. In this patient, plasma exchange therapy (PEX) successfully cleared the plasma from an initial hemolytic index of 2000 (equivalent to 2 g/dL hemoglobin, where optimetric laboratory evaluation is impossible) to an index of <50 (no detectable hemolysis). This allowed the PICU team to correct his coagulopathy, assess his degree of organ dysfunction, and provide routine laboratory assessments during continuous venovenous hemodiafiltration. After 9 single volume PEX sessions, his hemolysis and coagulopathy had resolved and his plasma had cleared sufficiently to permit routine laboratory assessments without difficulty. Multiorgan system support with an aggressive transfusion strategy, mechanical ventilation, inotropes, and continuous venovenous hemodiafiltration resulted in complete recovery. We conclude that in the presence of overwhelming hemolysis, plasma can become so icteric that optimetric laboratory evaluation is impossible. In this setting, PEX can be used to clear the plasma, restoring the ability to perform routine laboratory assessments.
KW - Hemolysis
KW - Loxoscelism
KW - Loxoscelosis
KW - Pediatric critical care
KW - Pediatrics
KW - Plasma exchange
UR - http://www.scopus.com/inward/record.url?scp=84908877216&partnerID=8YFLogxK
U2 - 10.1542/peds.2013-3338
DO - 10.1542/peds.2013-3338
M3 - Article
C2 - 25349320
AN - SCOPUS:84908877216
SN - 0031-4005
VL - 134
SP - e1464-e1467
JO - Pediatrics
JF - Pediatrics
IS - 5
ER -