The objective of this study was to determine the effect of blood exchange transfusion (ET) on hemodynamics, coagulation, gas exchange and cytokines in severely ill patients with sepsis syndrome. Eight previously healthy patients(2wks-16yrs), with sepsis syndrome due to N. meningitidis (n=2), enterococcus (n=1), S. aureus (n=1), and Varicella-zoster(n=2) presented with persistent hypotension in spite of fluid resuscitation and inotropic support. All were managed by a single volume ET. Vital signs, arterial blood gases, and coagulation studies were recorded pre, post and 6 hrs after ET. Blood was collected pre and post exchange for TNFα and IL-1β. PRISM score was 11± 2. Seven of 8 patients had DIC. Improvement in diastolic BP (47±4 vs 62±7, p=0.04), PTT (80±18 vs 43±7,p <0.007) and A-a gradient(334± 112 vs 201±53,p=0.05) was observed immediately following the ET. Seven of 8 patients survived. TNF was detected in 6/8 and IL-1 in 5/8 patients. Both TNF and IL-1 levels decreased following exchange transfusion except for the one non-survivor, whose IL-1 and TNF increased (Fig). No significant complications were observed from ET. Conclusions: Blood exchange transfusion improves cardiovascular stability, intrapulmonary shunting, and coagulopathy in patients with severe sepsis syndrome. The beneficial effects may be secondary to removal of inflammatory mediators during the exchange transfusion.

figure 1