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      Oxigenación por membrana extracorpórea y plasmaféresis en un paciente con hemorragia pulmonar grave secundaria a poliarteritis nodosa Translated title: Extracorporeal membrane oxygenation and plasmapheresis in the treatment of severe pulmonary hemorrhage secondary to nodose polyarteritis

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          Abstract

          Se comunica el caso de un paciente de 23 meses de edad, con hemorragia pulmonar, hipoxemia refractaria, hipertensión arterial y falla renal secundarias a poliarteritis nodosa (PN) que ha requerido asistencia simultánea con soporte cardiopulmonar extracorpóreo (ECMO), plasmaféresis, hemodiafiltración y surfactante exógeno. La PN es una vasculitis autoinmunitaria que afecta los vasos arteriales de pequeño y mediano calibres. La hipoxemia, refractaria al tratamiento con ventilación mecánica convencional y de alta frecuencia oscilatoria, fue sostenida con ECMO mientras se controló la enfermedad autoinmunitaria mediante plasmaféresis y tratamiento inmunosupresor. La combinación de ECMO con plasmaféresis es infrecuente, pero ha sido descripta en relación al trasplante de órganos, intoxicaciones, fallo cardíaco y sepsis. Existen dos casos descriptos en la bibliografía sobre el uso combinado de estas terapéuticas para el tratamiento de hemorragia pulmonar secundaria a vasculitis autoinmunitaria en niños.

          Translated abstract

          We report to simultaneous use of extracorporeal life support (ECLS), plasmapheresis, hemodiafiltration and exogenous surfactant for the treatment of pulmonary hemorrhage, arterial hypertension, and renal failure secondary to nodose polyarteritis (NPA) in a 23-month-old patient. NPA is an autoimmune disease that affects small -and medium- caliber muscular arteries. Hypoxemia refractory to treatment with conventional and high frequency oscillatory ventilation was supported by ECMO while awaiting control of the autoimmune disease through the use of plasmapheresis and immunosuppressive treatment. Although the combination of ECLS with plasmapheresis is rare, it has been described during the management of cases of organ transplant, intoxication, cardiac failure, and sepsis. There are only two previous reports describing the use of this combined therapy for the treatment of pulmonary hemorrhage secondary to autoimmune vasculitis in childhood.

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          Most cited references22

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          Extracorporeal Life Support in Severe Propranolol and Verapamil Intoxication

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            Acute postoperative biventricular failure associated with antiphospholipid antibody syndrome.

            Antiphospholipid syndrome is probably the most common acquired hypercoagulable state, but information on perioperative management is sparse. Minor alterations in anticoagulant therapy, infection, or a surgical insult may trigger widespread thrombosis. The perioperative course of a 31-yr-old woman with primary anticardiolipin antiphospholipid antibody syndrome requiring a mitral valve replacement is described. Postoperatively, she developed acute global biventricular failure requiring extracorporeal membrane oxygenation support and plasmapheresis. The management of anticoagulation and cardiac surgery in this condition is reviewed.
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              Successful treatment of cardiogenic shock caused by humoral cardiac allograft rejection.

              The progress of immunosuppressive therapy has made heart transplantation the standard therapy for end-stage heart failure. However, humoral rejection of the cardiac allograft is still a challenging problem associated with high incidence of graft loss and patient mortality. The present patient developed profound cardiogenic shock requiring extracorporeal life support on the 8th day after heart transplantation. Endomyocardial biopsy revealed no cellular rejection, and complement component C4d was positively stained on the capillary endothelium. The patient was successfully treated with repeated plasmapheresis and administration of anti-CD20 monoclonal antibody, rituximab, as well as with steroid pulse and increased standard immunosuppressive medication.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
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                Role: ND
                Role: ND
                Journal
                aap
                Archivos argentinos de pediatría
                Arch. argent. pediatr.
                Sociedad Argentina de Pediatría (Buenos Aires )
                1668-3501
                August 2012
                : 110
                : 4
                : e80-e85
                Affiliations
                [1 ] Hospital Universitario Austral Argentina
                Article
                S0325-00752012000400018
                9efa0a07-9911-46c3-b874-d4b57a4e225e

                http://creativecommons.org/licenses/by/4.0/

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                SciELO Argentina

                Self URI (journal page): http://www.scielo.org.ar/scielo.php?script=sci_serial&pid=0325-0075&lng=en
                Categories
                PEDIATRICS

                Pediatrics
                ECMO,Plasmapheresis,Nodose polyarteritis,Autoimmune vasculitis,Pulmonary hemorrhage,Plasmaféresis,Poliarteritis nodosa,Vasculitis autoinmunitaria,Hemorragia pulmonar

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