Exchange Transfusion in Reye's Syndrome with Saline‐Washed Red Blood Cells

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Abstract
Reye''s syndrome (RS) consists of encephalopathy, fatty degeneration of viscera and elevation of ammonia, certain amino acids and liver enzymes in the blood. It is most characteristically a disease of children and has been considered to have a poor prognosis despite the use of various treatment regimens. Exchange transfusion (ET) with fresh blood (less than 24 h old) for the removal of toxic metabolic byproducts in RS is a relatively recent development which appears to have improved the survival rates. Because RS may occur in epidemic proportions at any time the demand for fresh blood can place an excessive stress on blood resources. Utilized saline-washed (to remove potentially toxic metabolites) red blood cells (RCS''s) less than 6 days old, and fresh frozen citrate-phosphate-dextrose (CPD) plasma was used in treating this disorder. Nine patients in the Milwaukee [Wisconsin, USA] community with severe encephalopathy secondary to RS were treated with ET. These patients collectively required 151 units of washed RBC''s for 21 ET. Of 9 patients, 8 survived without sequelae. Age of blood used did not correlate with the number of exchanges required or the eventual outcome. A continual computerized EEG in 5 patients provided objective evidence of the effectiveness of ET. ET with saline-washed RBC''s reconstituted with fresh frozen plasma (FFP) is a fast, safe and effective means of treating patients with RS.