PLASMAPHERESIS IN PEDIATRIX

Voinov V.A.
I.P.Pavlov first Saint-Petersburg state medical university, Saint-Petersburg, Russia.
The plasmapheresis finds the broadest application in the most different fields of medicine,
but it isn't less indications to it and for children of the first months and years have lives also.
There is and the severity of a course of inflammatory diseases of lungs and abdominal organs
caused by inferiority still of system of immune protection at children of early. And infectious
diseases, including hepatitis, diphtheria, intestinal infections, etc. The plasma exchange promotes
faster knocking over of manifestations of the poured purulent and acute liver failure at children.
The plasma exchange was effective and in treatment of the secondary purulent meningitis
complicating purulent polysinusitis and mastoiditis also. Besides, at children, also as well as at
adults, indications to apheresis therapy arise at poisonings, burns, injuries, etc. In addition,
among indications to a plasma exchange at children also pneumonia, sepsis, the DIC-syndrome,
meningitis, and intestinal infections are specified. At a hemolytico-uraemic syndrome the plasma
exchange appeared more effective, than a hemodialysis.
Allergic diseases, and not only widespread allergy dermatitis (diathesis), but also asthmatic
bronchitis which if not to take timely measures for normalization of an immunoreactivity,
threaten with chronization and transition to the real bronchial asthma of adults are rather
frequent. The peak of incidence of allergic rhinitises, in particular, is the share of age of 3-4 years
and without treatment a bronchial asthma develops in 40% (!) of cases. Epidemiological
researches of the last years show that from 10 to 20% of children of the whole world have
bronchial asthma.
The severe and long current accepts atopic dermatitis at children with an intensive itch,
papular rashes, a lichenization. It hardly gives in to traditional treatment, even with use of steroid
preparations and cytostatics. The plasmapheresis courses at such children allowed to stop much
quicker these symptoms of dermatitis in comparison with comparable control group on
SCORAD scale. And at development of a toxic epidermal necrolisis the plasma exchange also
with success is applied.
Quite often and autoimmune diseases begin at children's age also, for example
glomerulonephritis, vasculitis, rheumatism. Thus, than earlier, just at the first symptoms of these
diseases, to remove the formed antibodies out of an organism, than it is more chances to prevent
organic damages of appropriate organs. Thus, even if not at each child permanent damages of
kidneys at a glomerulonephritis or heart valves at rheumatism will develop, use of almost safe
and harmless method of apheresis therapy, such as a plasmapheresis, it is necessary to consider
justified. Carrying out a plasmapheresis at early stages of an illness considerably improves the
forecast of recovery. At severe damages of kidneys including as preparation for transplantation,
and also for prevention of crises of rejection with success the plasma exchange is.
At children's age there are also neurologic autoimmune diseases, such as a syndrome to
Gilain-Barr, the chronic inflammatory demyelinating polyneuropathy, a juvenile myasthenia

and juvenile dermatomyositis. The medical protocols based on practice of treatment of adults
threaten with such secondary complications as a growth retardation of the child, demineralization
of bones, body weight problems. Often an obstacle for carrying out a plasma exchange at such
children is the limited vascular access only.
Insulin dependant diabetes can also begin at children's age, but the long prodromal period
doesn't give the chance in due time to provide pathogenetic therapy. However at the adjusted
dispensary accounting of groups of risk with periodic researches of an immune background
possibility of detection can be reached autoantibodies to -cells at the earliest stages of an
illness. It will allow to begin preventive apheresis therapy when the considerable mass of these
cells is still kept and there is a hope, at least, to slow down process of their autoimmune
destruction. Besides, the plasmapheresis is capable to prevent also many vascular complications
of diabetes (a retinopathy, a nephropathy, polyneuropathy) which medicamentous therapy isn't
effective.
Use of a plasma exchange over the last ten years increased in children's hospitals of the
USA, especially at thrombotic thrombocytopenic purpura, Goodpasturs syndrome and a
myasthenia.
But it should be noted a number of technical difficulties of carrying out a plasma exchange at
children, connected, both with a small mass of their bodies, and with restrictions of possibility of
their vessels use. Not each device can be used in pediatric practice. Nevertheless if indications
for a plasmapheresis are undoubted, then it, of course, has to be carried out. The Russian Rosa
plasma filters and the portable device "Hemofenix" are quite suitable for their use at children
even the earliest age.