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Hematologic Disorders in Children with Continuous Renal Replacement Therapies

Fabra, Celia; Infante, Sara; Miras, Isabel; Pretus, Susana; Santiago, María José; Fernández, Sarah N.; López-Herce, Jesús

doi: 10.1097/MAT.0000000000000637
Original Article: PDF Only

The objective of this study was to analyze hematologic disorders, coagulation disorders, and transfusion requirements in children with continuous renal replacement therapies (CRRT). This is a retrospective analysis of a prospectively collected database of children receiving CRRT between 2010 and 2015. Patient characteristics, CRRT parameters, hematologic and coagulation parameters, and need for transfusions were recorded and analyzed. We compared patients after heart surgery and noncardiac patients, those requiring extracorporeal membrane oxygenation (ECMO) and those without ECMO, and patients with different anticoagulation therapies: heparin and citrate. Eighty-seven patients were included (69% after heart surgery). Thirty-four percentage of patients required ECMO. Hematologic alterations throughout the therapy included a descent in hematocrit from 33.6% to 30.3% (p = 0.002) and in platelet count from 159.291 to 101.163 (p < 0.001). Coagulation parameters improved as international normalized ratio decreased from 1.5 to 1.2 (p < 0.001), fibrinogen increased from 328 to 437 mg/dl (p = 0.04), and TTPA was normalized. There were no significant differences in hematologic parameters or need for blood products between patients after heart surgery and the rest of patients, or between patients receiving heparin or citrate for anticoagulation. Ninety percentage of patients received blood products, but patients on ECMO and those who deceased required more transfusions than the rest of the patients (p < 0.01). We conclude that children undergoing CRRT show a descent in hematocrit and platelet count and require large amounts of blood products, especially those ECMO and patients who died.

From the Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón de Madrid, Instituto de Investigación Sanitaria del Hospital Gregorio Marañón Facultad de Medicina, Universidad Complutense de Madrid, España.

Submitted for consideration February 2017; accepted for publication in revised form May 2017.

Disclosure: The authors have no conflicts of interest to report.

This work was supported by grant PI12/0128 from Carlos III Institute of Health, Spain. Subdirección General de Evaluación y Fomento de la Investigación y el Fondo Europeo de Desarrollo Regional (FEDER).

Correspondence: Jesús López-Herce, Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Dr Castelo 47 28009 Madrid, Spain. Email:

Copyright © 2018 by the American Society for Artificial Internal Organs