Abstract: Objective  To explore the efficacy and safety of regional citrate anticoagulation (RCA) method for plasma exchange (PE) in children. Method  Eighteen children received PE treatment in a total of 48 times at the Department of Nephrology, Rheumatology and Immunology, Hunan Children's Hospital from February 2021 to June 2023 were enrolled in this study; they were used RCA for PE because they had medium or above medium bleeding risk after a bleeding risk assessment. The control group consisted of 28 children using heparin anticoagulation for PE in a total of 84 times in the same period. Blood calcium ion and bicarbonate ion were compared before and after the treatment in RCA group.  Bleeding and clotting in filters were compared between RCA group and control group.  Result  In RCA group, calcium ion in peripheral blood decreased significantly on PE for 1h and after PE as compared to the blood calcium ion before PE (1.00±0.10 vs. 1.18±0.09, t=9.543, P＜0.001; 0.88±0.13 vs. 1.18±0.09, t=15.948, P＜0.001), but no patients had blood calcium ion ＜0.7mmol/L after PE; blood bicarbonate ion after PE increased significantly as compared to the level before PE (32.53±4.44 vs. 28.29±4.53, t=9.942, P＜0.001); the rate of metabolic alkalosis was higher after PE than before PE (83.33% vs. 45.83%, c2=10.723, P＜0.001). All patients had no extracorporeal circulation coagulation events that interrupted the treatment. The rate of clotting in filters had no significant difference between RCA group and control group (4.17% vs. 7.14%, c2=0.475, P=0.488). In RCA group, the effective anticoagulation rate was higher in the patients with the after filter calcium ion concentration ＜0.45mmol/L than in those with the concentration ≥0.45mmol/L (97.73% vs. 75.00%, P=0.005). There was no significant difference in bleeding between the two groups. The symptoms of hypocalcemia such as limb numbness, muscle twitching or arrhythmia during PE were not found in all of the patients.  Conclusion  The use of RCA for pediatric plasma exchange therapy is relatively simple and safe. This method can be effectively used for pediatric plasma exchange therapy.

Key words: Regional citrate anticoagulation, Plasma exchange, Children