OBJECTIVES: To study the indication for therapeutic plasma exchange (TPE) and related complications in children admitted to the pediatric intensive care unit. METHODS: A retrospective analysis was performed on the medical records of the children who received TPE in the Pediatric Intensive Care Unit, Hunan Children's Hospital, from March 2015 to March 2021. The indication for TPE and related complications were analyzed and compared with the American Society for Apheresis (ASFA) indication categories. RESULTS: A total of 405 TPE treatment sessions were performed for 196 children, among whom 76 children (38.8%) also received continuous renal replacement therapy and 147 children (75.0%) survived. The children with neurological diseases had the highest survival rate of 93.1% (27/29). The top three indications for TPE were hematologic diseases (61/196, 31.1%), sepsis with multiple organ dysfunction (41/196, 20.9%), and liver diseases (36/196, 18.4%). The children with hematologic diseases received the highest number of 129 TPE treatment sessions. The subjects with ASFA category Ⅲ indications accounted for the highest proportion of 76.5% (150/196), followed by those with ASFA category Ⅰ indications (11.2%, 22/196), ASFA category Ⅱ indications (7.1%, 14/196), and unknown category (5.1%, 10/196), and no ASFA category Ⅳ indications were observed. The incidence rate of TPE complications was 12.3% (50/405), and the most common complications were pipeline coagulation (4.2%, 17/405) and hypotension (3.7%, 15/405). No serious adverse events were observed. CONCLUSIONS TPE can be safely used for the treatment of critically ill children with indications in an experienced pediatric intensive care unit.
Child ; Humans ; United States ; Plasma Exchange/adverse effects* ; Retrospective Studies ; Intensive Care Units, Pediatric ; Sepsis/etiology* ; Hematologic Diseases/therapy*

OBJECTIVETo understand the current epidemic situation and high risk factors of human immunodeficiency virus (HIV) infection among paid blood donors living in Shandong provincial China Comprehensive Response (CARES) Project Areas.

METHODSAll residents between 20 to 60 years old were selected from one or several counties in August 2003.

RESULTSThere were 19 HIV(+) infections among 661 subjects interviewed. HIV prevalence rate among paid blood donors was higher (3.98%) than that of others (0.48%) while HIV prevalence rate was higher in plasma donors (7.24%) than that in both plasma and full blood donors (2.90%). There was no infections identified in full blood donors. Donors who donated blood during 1994 - 1995 had a higher prevalence rate (7.07%) than those who started donation after 1995 and those began donation before 1993 (0.99%). The rate of condom use was lower among paid blood donors (13.72%) than that of others. There was a lower rate of voluntary HIV testing among paid blood donors than that of others.

CONCLUSIONThe main high risk population of HIV infection were paid donors in CARES Project Areas, whose risk factor was plasma donation and were infected mainly before 1995. Both the rate of condom use and HIV testing were all very low, indicating that they knew little on HIV/AIDS and paid less attention to self-proctection. It is necessary to enhance HIV/AIDS health education and behavior intervention on paid blood donors.

Adult ; Blood Donors ; China ; epidemiology ; Female ; HIV Infections ; epidemiology ; HIV Seroprevalence ; HIV-1 ; Humans ; Incidence ; Male ; Middle Aged ; Plasma Exchange ; adverse effects ; Risk Factors ; Seroepidemiologic Studies

OBJECTIVETo study the time span from human immunodeficiency virus (HIV) infection to full bloom AIDS and to death.

METHODSAmong formal plasma donors (FPD) from 2 counties in central China, 178 HIV cases were confirmed by western blot method but received no ARV treatment under a retrospective cohort study. Data on personal information, history on plasma donation, as well as dates regarding HIV diagnostic confirmation, onset of AIDS and death was collected through reviewing laboratory and medical records thus the course of disease for each case was identified. Incubation and survival time were calculated, using Kaplan-Meier method.

RESULTSThe incubation period was 8.31 years on average (95% CI: 8.04 - 8.58 years). The cumulative incidence rate of AIDS was 6.41/100 person-years after HIV infection. The survival time was 9.90 (95% CI: 8.20 - 11.60) months after the onset of AIDS.

CONCLUSIONAccording to the findings from this study, the average incubation was shorter than 9.5 years which was reported by UNAIDS. Comparing with figures that had been reported by UNAIDS, AIDS incidence rate among this population was lower within 6 years but higher since the 7th year on after being infected but the survival time was shorter.

Acquired Immunodeficiency Syndrome ; epidemiology ; transmission ; Adolescent ; Adult ; Blood Donors ; China ; epidemiology ; Cohort Studies ; Female ; Humans ; Male ; Middle Aged ; Plasma Exchange ; adverse effects ; Prevalence ; Retrospective Studies

Despite the fact that any drug can be an impending cause of hypersensitivity reactions, Ibuprofen, an over-the-counter drug used extensively as an analgesic and antipyretic in Asia, is considered to be relatively safe. But herein we report a rare extremely 'rapid onset' occurrence of a severe case of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in a 22-year-old male, induced by 3 doses of 400 mg of Ibuprofen taken at 8-hour interval for eye pain, probably the first case report of rapid onset of TEN by nonsteroidal antiinflammatory drugs in Nepal. SJS and TEN are idiosyncratic, delayed hypersensitivity inflammatory adverse drug reactions that are severe adverse cutaneous drug reactions which predominantly involve the skin and mucous membranes and are linked with high morbidity and mortality. Nevertheless, removal of ibuprofen and its metabolites with plasma exchange and treatment with antibiotics and intravenous corticosteroids along with supportive therapy improved the course of the disorder. This rare case report addresses the fact that severe hypersensitivity reactions can occur with Ibuprofen, which can be potentially dangerous and life threatening. It is thus important for the clinicians to be alert to such severe hypersensitivity reactions even with drugs which are deemed to be probably safe.
Adrenal Cortex Hormones ; Anti-Bacterial Agents ; Asia ; Drug-Related Side Effects and Adverse Reactions ; Eye Pain ; Humans ; Hypersensitivity ; Hypersensitivity, Delayed ; Ibuprofen ; Immune System Diseases ; Male ; Mortality ; Mucous Membrane ; Nepal ; Plasma Exchange ; Skin ; Stevens-Johnson Syndrome ; Young Adult

A 32-yr-old male diagnosed with myelodysplastic syndrome underwent an unmanipulated, unrelated, HLA matched, peripheral blood stem cell transplantation. The patient and donor were both blood type O, CcDEe. Twelve weeks post-transplantation, he developed acute autoimmune hemolytic anemia (AIHA). He was transfused multiple times with washed O red cells. High-dose steroid therapy was initiated and he underwent splenectomy; however, AIHA was refractory to therapy. The patient was further treated with combined treatment modalities including immunosuppressive therapy with mycophenolate mofetil and cyclosporine and three cycles of plasma exchange, and AIHA responded to treatment. This is the third case of AIHA complicating hematopoietic stem cell transplantation reported in Korea. Since AIHA is relatively common after hematopoietic stem cell transplantation, accurate and timely diagnosis of the disease and treatment strategies with multiple modalities are necessary.
Adult ; Anemia, Hemolytic, Autoimmune/*diagnosis/drug therapy/etiology ; Combined Modality Therapy ; Cyclosporine/therapeutic use ; Hematopoietic Stem Cell Transplantation/*adverse effects ; Humans ; Male ; Mycophenolic Acid/analogs & derivatives/therapeutic use ; Myelodysplastic Syndromes/complications/diagnosis/therapy ; Plasma Exchange