Analysis Of Therapeutic Effect Of Plasma Exchange On Severe Autoimmune Hemolytic Anemia In 21 Children

Objective: To understand the efficacy and safety of blood purification therapy for children with autoimmune hemolytic anemia in China.Methods: According to the registration form for treatment of autoimmune hemolytic anemia plasma exchange,drawn up by experts from the professional committee of blood purification of the pediatric branch of the Chinese Medical Doctors Association,the clinical data of autoimmune hemolytic anemia(AHA)patients undergoing blood exchange in some hospitals in China were collected by questionnaire and analyzed retrospectively.Results:1.Case composition:there were 21 cases of AHA treated by blood purification in 7 hospitals,17 of which were from PICU and the others from the department of nephrology.11 males,10females,males:females was 1.1:1,average age was 3.64(0.25-11.1 years old).20 cases in plasma exchange(PE),1 case in PE+continuous renal replacement therapy(CRRT).2.Etiology:15 cases(71.4%)with infection,4 cases(19%)with unknown,2 cases(9.5%)with autoimmune diseases.3.Clinical manifestation : Anemia was found in 20 patients(95.2%)before replacement,complete remission in 15 patients(75%)and partial remission in 5 patients(25%)after replacement.There were 18 cases(85.7%)with jaundice before replacement,12 cases with complete remission(66.6%)and 6 cases with partial remission(33.3%).There were 11 cases of hepatosplenomegaly(52.4%)before replacement,10 cases of complete remission(91%)and 1 case of partial remission(9%)after replacement.There were 4 patients(19%)with disturbance of consciousness before replacement and 4 patients with complete remission after replacement(100%).The volume of blood decreased in 2 cases(9.5%)and completely relieved in 2 cases(100%).4.Laboratory indicators : Before treatment,erythrocyte [(1.75 ± 0.86)10 ^ 9/L ] and hemoglobin [(58.25 ± 24.19)g/L ] decreased significantly,total bilirubin [(113.31 ± 115.65)umol/L ] and indirect bilirubin [(60.29 ± 34.46)umol/L ] increased significantly,urea nitrogen[(7.51 ± 4.30)mmol/L ] and Lactate dehydrogenase [(1232.77 + 1158.70)IU/l ] were lower than before,all the above indexes were improved after replacement [(2.98 ± 0.52)10 ^ 9/L,(92.73 ± 15.08)g/l,(32.08 ± 31.46)umol/l,(17.20 ± 15.45)umol/L,(4.73±2.14)mmol/L、(713.17+743.21)IU/L],there were significant differences between pre-and post-replacement(p < 0.05).5.Outcome : Partial remission occurred in 16 cases(76%),complete remission in 2 cases(9.5%)and discharge from hospital in 3 cases(14%).Conclusion:Plasma exchange can obviously improve the clinical manifestation and laboratory indicators of children with autoimmune hemolytic anemia,which is not effective in conservative therapy.It can be used as a therapeutic measure for children with severe AHA and has better safety.