Therapeutic Plasma Exchange in Children with Neutropenic Sepsis: Single Center Experience

Objective: The mortality rate is high for severe sepsis and septic shock. Presently, there are no specific treatments that can reduce mortality in patients with sepsis and multiple organ dysfunction. Therapeutic plasma exchange (TPE) is the automatic separation of a patient's plasma using medical devices and its replacement with healthy donor plasma. TPE may be beneficial in selected cases, even though not routinely recommended by international sepsis guidelines. Methods: For the present study, file records of three children with neutropenic sepsis who had undergone TPE between March 2015 and June 2016 were retrospectively reviewed. Results: Two patients with acute leukemia, one patient with stage IV Burkitt lymphoma. All patients showed positive blood cultures. Candida krusei with Klebsiella pneumoniae was isolated in one patient, K. pneumoniae was isolated in the other patient, and C. krusei in the last patient. Multiple organ dysfunction developed in all patients and they showed no response to supportive therapy. Plasma exchange was performed 5, 1, and 13 times, respectively. After TPE, two patients fully recovered and one patient died due to natural course of the disease. None of the children developed complications associated with this procedure. Conclusion: TPE may be considered as an alternative treatment in children with neutropenic sepsis and multiple organ failure who do not respond to conventional sepsis treatment.