INTENSIVE BLOOD AND PLASMA-EXCHANGE FOR TREATMENT OF COAGULOPATHY IN MENINGOCOCCEMIA

Eight pediatric patients with fulminant meningococcemia, purpura, and disseminated intravascular coagulation who by multiple prognostic scor ing systems were anticipated to have a poor outcome underwent intensiv e plasma exchange (IPE) or whole blood exchange (WEE) in addition to s tandard medical therapy. IPE/WBE was initiated shortly after admission with a mixture of both fresh frozen plasma and cryoprecipitate as the replacement solution. All IPE procedures were performed using a conti nuous flow system and a red cell prime. The mean fibrinogen level incr eased from 62 to 192 mg/dl, the prothrombin time (PT) decreased from a mean of 32.4 seconds to 15.1 seconds, and the mean activated partial thromboplastin time (APTT) decreased from 89.5 seconds to 40.1 seconds following completion of the initial IPE/WBE. There was a correspondin g improvement in all coagulation factor levels but only slight improve ment in antithrombin III (ATIII) and protein C levels. Seven of eight patients survived (87.5%) their initial presentation with the sole ear ly death attributed to meningitis with cerebral edema. Mean fluid bala nce after the procedure was +10.8 +/- 5.87 cc/kg. There were no signif icant bleeding or cardiovascular complications during the procedure. T here was no clinical or radiographic evidence of fluid overload after the procedure. This experience demonstrates that IPE/WBE may be conduc ted safely in critically ill, unstable pediatric patients and is effec tive in rapidly improving coagulopathy without fluid overload. (C) 199 5 Wiley-Liss, Inc.