Therapeutic Plasma Exchange/Apheresis Management Note (Pediatrics)

Date/Time: [Date and time of documentation] Location: [ICU / floor / outpatient / other]

Procedure Type: [TPE / other apheresis modality (specify)]

Treatment Number: [X of planned Y / X of ongoing series (no defined endpoint)] (Do not infer total planned number unless explicitly decided.)

Urgency: [scheduled / urgent / emergent]

Encounter Status: [procedure planned (not yet performed) / performed today (completed) / attempted and aborted or terminated early]

Indication and Clinical Context

[Working diagnosis and clinical syndrome prompting apheresis; therapeutic rationale for today (therapeutic vs diagnostic bridge vs rescue); relevant disease severity features including organ involvement, hemodynamics, and neurologic status; goals-of-care constraints or consent limitations if applicable; ASFA category if institutional practice] (Use one to two concise paragraphs. If indication is unclear, explicitly state that clarification is pending from the primary team rather than inferring a diagnosis.)

Risk Factors and Contraindications

[Patient-specific risks: unstable hemodynamics, active bleeding, severe hypocalcemia, significant coagulopathy, access limitations, transfusion reaction history, liver dysfunction affecting citrate metabolism, concurrent extracorporeal therapies, or other relevant factors; planned mitigation steps for each identified risk] (Include this section only if clinically relevant risks are present; omit entirely for straightforward low-risk encounters.)

Pre-Procedure Assessment

• Patient: [Weight in kg] (Required for pediatric dosing—if unavailable, explicitly flag: "Weight unavailable; dosing cannot be finalized.") [Estimated total blood volume if used by service] [Current hemodynamic and respiratory support status] [Temperature management needs if applicable]
• Vascular Access: [Access type and site] [Line condition and patency] [Flow limitations or prior complications] [Site assessment findings]
• Relevant Medications/Allergies: [Allergies to replacement fluids or anticoagulants] [Current anticoagulants or antiplatelets] [Baseline calcium or magnesium supplementation if relevant]
• Pre-Procedure Labs: [CBC with platelets - value (time)] [Electrolytes with ionized calcium - value (time)] [Coagulation studies and fibrinogen - value (time)] (Include coags when bleeding risk is relevant or with frequent albumin-based exchanges.) [Hemolysis markers if applicable - LDH, haptoglobin, bilirubin - value (time)] [Disease-specific tests if applicable - value (time)] [Pending labs and expected availability] (Do not copy forward stale labs without timestamps.)

Consent and Verification

• Informed Consent: [obtained / not obtained] (If obtained: by whom and from whom. If not obtained: document reason and plan.)
• Blood Product Consent: [obtained / not required / pending] (Include if plasma or RBC prime is planned.)
• Time-Out: [completed - date/time / not completed - reason] (Do not mark as completed unless it actually occurred.)

Apheresis Prescription

• Modality and Dose: [TPE / other modality] [Exchange dose in plasma volumes and/or calculated mL] [Treatment schedule: daily / every 48 hours / other] [Target endpoints for continuation or stopping with measurable markers]
• Replacement Fluid: [Fluid type: albumin % / plasma / combination] [Planned volumes or proportions] [Rationale for selection] [ABO or special product requirements if applicable] [Premedication plan if plasma and reaction history]
• Anticoagulation: [Anticoagulant type: citrate / heparin / combination] [Regional vs systemic] [Starting parameters per protocol] [Adjustment rules for symptoms or circuit issues] [Special considerations for liver dysfunction or high plasma exposure if applicable]
• Calcium Management: [Prophylactic vs PRN approach] [Route and formulation] [Monitoring frequency for symptoms and ionized calcium] [Escalation steps for symptomatic hypocalcemia] [Magnesium plan if part of local practice]
• Priming Plan: [RBC prime planned / not applicable] [Prime composition and volume] [Transfusion reaction mitigation if applicable] (Include only for small or hemodynamically tenuous patients, or when extracorporeal volume is a meaningful fraction of total blood volume. Omit entirely when not applicable.)
• Monitoring and Stop Criteria: [Vital sign and circuit monitoring frequency] [Lab monitoring plan during and after procedure] [Stop criteria: hemodynamic instability unresponsive to intervention, severe reaction, access failure, uncontrolled bleeding]

Procedure Summary

(Include this entire section only if the procedure was performed or attempted today. Omit entirely if the procedure has not yet occurred.)

• Timing and Status: [Start time] [Stop time] [Completed / terminated early with reason]
• Delivered: [Volume processed/exchanged] [Replacement fluid actually given - type and volume] [Anticoagulant used and any adjustments] [Calcium administered - prophylactic doses and any rescue doses]
• Access Performance: [Inlet and return adequacy] [Access complications if any: positional issues, alarms, infiltration, bleeding at site]
• Adverse Events: [None] or [Event type, severity, patient-reported symptom in quotes if relevant, intervention taken, outcome] (Document each event separately if multiple occurred.)

Post-Procedure Assessment

(Include only if the procedure was performed or attempted.)

• Immediate Status: [Hemodynamics, symptoms, brief exam findings]
• Post-Procedure Labs: [Results obtained with times] [Labs ordered and expected times]
• Access Site: [Site condition, hemostasis, patency]
• Fluid Balance and Disposition: [Net fluid balance if tracked] [Disposition and level of care]

Response Assessment

[Response tied to indication using trends: hemolysis markers, platelet trend, neurologic status, renal function, or other indication-specific metrics as applicable] [Pending diagnostic studies and how results will affect treatment plan] (Document temporal associations and objective changes without inferring causality unless explicitly justified. For first treatment or if not yet performed, state baseline status and parameters to be tracked prospectively.)

Assessment and Plan

• Primary Indication: [Current status and response assessment] [Plan for continuation or discontinuation with criteria]
• Procedure Tolerance: [Summary of tolerance and any complications requiring follow-up] (Omit if no issues.)
• Vascular Access: [Current issues and management plan] (Omit if no issues.)
• Bleeding/Coagulation: [Considerations, fibrinogen/INR targets, product strategy if needed] (Include only if relevant.)
• Electrolytes: [Calcium, magnesium, potassium management if issues identified] (Include only if relevant.)
• Next Treatment: [Date/time or triggering condition] [Parameter changes planned] [Required pre-procedure labs and timing]

Communication

[Discussion with primary/referring team and recommendations conveyed] [Blood bank coordination if products needed] [Family updates if performed] (Omit routine logistics unless clinically relevant to timing, product availability, or safety.)