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Clinical Pediatrics
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Reversal of Central Nervous System Involvement in Hemolytic Uremic Syndrome by Use of Plasma Exchanges

Kumudchandra J. Sheth

Department of Pediatrics, Medical College of Wisconin, Children's Hospital of Wisconsin, and The Blood Center of Southeasten Wisconsin, Milwaukee, Wisconsin

Heinz E. Leichter

Department of Pediatrics, Medical College of Wisconin, Children's Hospital of Wisconsin, and The Blood Center of Southeasten Wisconsin, Milwaukee, Wisconsin

Joan C. Gill

Department of Pediatrics, Medical College of Wisconin, Children's Hospital of Wisconsin, and The Blood Center of Southeasten Wisconsin, Milwaukee, Wisconsin

Anne Baumgardt

Department of Pediatrics, Medical College of Wisconin, Children's Hospital of Wisconsin, and The Blood Center of Southeasten Wisconsin, Milwaukee, Wisconsin

A 12-year-old girl presented with weakness, diplopia, and lethargy after a prodrome of gastroenteritis. Laboratory studies were compatible with a diagnosis of hemolytic uremic syndrome. She developed seizures that were controlled by diphenylhydantoin and valium. In spite of peritoneal dialysis and fresh frozen plasma infusions, she progressed to a left hemiplegia associated with a brain scan finding of decreased blood flow in the right middle cerebral artery perfusion area. A 5 liter whole blood exchange transfusion did not improve the neurological status or low platelet count. Daily plasma exchanges with fresh frozen plasma replacement resulted in normal platelet count within 48 hours and was followed by progressive improvement in neurological status. Platelet agglutinating factor decreased to control levels. A repeat brain scan was normal.

Clinical Pediatrics, Vol. 26, No. 12, 651-656 (1987)
DOI: 10.1177/000992288702601208
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J. D. Tobias, D. K. Baker, and C. A. Hurwitz
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[Abstract] [PDF]