Introduction: Therapeutic plasma exchange (TPE) is an extracorporeal therapy, used in a wide spectrum of diseases. The aim of our study is to analyze the indications and outcomes of TPE in critically ill children at a University Children Hospital.
Methods: This is a retrospective study including all patients admitted to pediatric intensive care unit (PICU), who underwent TPE starting from 2018 to 2022. Demographic data, vital signs, laboratory investigations at PICU admission and upon discharge were recorded. The number of PE sessions needed for each patient, volume of exchange, replacement fluid, site of IV access, complications during sessions, and the outcomes were documented.
Results: Seventy-five critically ill pediatric patients who underwent 450 TPE sessions were enrolled. Guillain-Barré syndrome (GBS) was the commonest indication for TPE in 45(60%) patients, 23(30.7%) of them were with severe motor axonal degeneration subtype. Severe autoimmune hemolytic anemia (AIHA) with failed first line of management accounted for 21(28%) children. The mean number of TPE sessions needed for every patient was 6±4 sessions. TPE sessions related complications were minimally significant. Mortality was 12% of the study group and related to respiratory support. 
Conclusion: TPE carries the hope for cure of many autoimmune disorders, even as a first line of therapy in many conditions. GBS patients account for the majority of our TPE indication, and a satisfactory outcome was observed in AIHA patients. Further studies are needed to augment our results that more than 5 TPE sessions are sometimes needed in selected severe GBS patients.