Abstract

Hematologic filtration techniques increased very quickly in interest and application as adiuvant treatment for systemic Hyper inflammatory conditions. “High Level” mortality conditions as Septic Shock and Sepsis are still highly present if we consider the continuous therapeutical progress.

This is the clinical-therapeutic report of a female patient observed in September 2016, aged 4 ,affected by HLH secondary to bacterial infection ; the patient also developed a secondary SDR with abnormal us macrophagic activation during septic shock and sepsis with MOF evidence status. The patient received mechanical controlled ventilation, strong cardiovascular drugs support, increase of volemia , CRRT, CVVHDF, intermittent plasmapheresis; a “Cytosorb Absorber” was added to the plasmapheresis circuit.

There was no Ethical Committee consent and the use of “Cytosorb”, not approved for pediatrics weighting less than 40kgs, has been done in ”Emminentia Mortis”. We observed, after the first 12 hours of Conventional Hemodiafiltration plus Cytosorb application, a very rapid improvement of cardiovascular and respiratory patterns, a rapid decrease of hyperammonemia, improvement of renal and hepatic functionality, a quick decrease of inflammatory markers. The hemodiafiltration was continued, Cytosorb was added with a 24 hrs interval and Plasmapheresis treatment was continued. In a few days there was a normalization of clinical condition with resolution of sepsis and MOF.

Conclusion: There is a very little experience in the use of pediatric purification techniques especially in the use of Cytosorb. This is the first pediatric treatment with Hemodiafiltration, Plasmapheresis and Cytosorb in a case of a confirmed Hamofagocytic Histiocytosis disease. Further studies and informations are required.

Keywords: Hemofiltration techniques; Haemophagocityc Histyocitosis; Sepsis; Septic Shock; Cytosorb Absorber