ĐẶC ĐIỂM ĐIỀU TRỊ THAY HUYẾT TƯƠNG Ở TRẺ VIÊM NÃO TỰ MIỄN TẠI BỆNH VIỆN NHI ĐỒNG 2

Abstract

Background: Autoimmune encephalitis (AE) can cause serious complications and therapeutic plasma exchange (TPE) may be the treatment of choice. However, safety and effectiveness need to be thoroughly tested. Objective: Characterize the use of TPE in children with AE at Children's Hospital No. 2. Methods: A retrospective case series was conducted on patients diagnosed with AE who received TPE from January 2019 to June 2022. Results: Of the 36 AE cases received TPE, the majority (94.4%) were severe, with a median age of 7.4 and median weight of 24.4 kg. A total of 210 TPE cycles were performed, with a median of 6 sessions per patient and a median duration of 11.5 days. The median replacement fluid volume was 1690 mL per session, with 61.1% of patients receiving fresh frozen plasma (FFP), 30.6% receiving albumin, and 8.3% receiving a combination of FFP and albumin. During the procedure, 11.4% of patients experienced anaphylactic reactions (with a higher incidence in the FFP group) and 3.8% experienced hypotension. Hypocalcemia was observed in 44.9% of cycles, with symptomatic hypocalcemia occurring in 1% of patients. After TPE, 44.4% of patients developed nosocomial infections. 94.4% of patients were discharged, with 69.4% showing improvement. There was no significant difference in improvement rates between the use of albumin or FFP as a replacement fluid in TPE. A higher improvement rate was observed in patients who received TPE within 28 days of onset. Conclusions: Both FFP and albumin can be used as replacement fluids in TPE for children with autoimmune encephalitis. The utilization of TPE should be approached with caution and reserved solely for severe or unfavorable AE, as it involves an invasive procedure that may induce side effects. Close monitoring is necessary to identify and swiftly address any potential complications, particularly prophylaxis for anaphylaxis when using FFP and nosocomial infections.