What is the role of plasma infusion in the treatment of pediatric atypical hemolytic uremic syndrome (aHUS)?

Updated: Nov 12, 2018
  • Author: Robert S Gillespie, MD, MPH; Chief Editor: Craig B Langman, MD  more...
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Answer

Plasma infusion consists of simply infusing donor plasma, such as FFP or cryoprecipitate-reduced plasma. In theory, this delivers the absent or abnormal vWF metalloproteinase or complement factors. Plasma infusion does not remove the abnormal factors, as TPE does.

The sole advantage of plasma infusion over TPE is its simplicity, because it can be performed in almost any medical facility and does not require specialized equipment, central venous access, or specially trained staff. Studies comparing TPE to plasma infusion have found superior outcomes with TPE. [23]

Infusions typically consist of 20-30 mL of FFP or cryoprecipitate-reduced plasma per kilogram. One case report found 40-45 mL/kg infusions necessary. [24]

Volume overload may complicate plasma infusion, especially in patients with reduced renal function. For example, a 50-kg child receiving 40 mL/kg of plasma would require a 2000 mL infusion, approximately equal to the entire daily fluid requirement for a patient with normal renal function. The risk of volume overload may limit the volume administered, reducing the effectiveness of the therapy.

Hyperproteinemia, as shown by elevated serum total protein, has been reported in a patient receiving long-term plasma infusions.

In theory, one can use exclusively cryoprecipitate-reduced plasma for plasma infusion because the patient's own coagulation factors are not removed.


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