{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T09:56:19Z","timestamp":1753869379797,"version":"3.41.2"},"reference-count":10,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,5,22]],"date-time":"2025-05-22T00:00:00Z","timestamp":1747872000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Clinical Apheresis"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:p>This report details a rare pediatric case of hyperammonemic encephalopathy caused by the oral iron chelating drug deferasirox (DFR) in a septic patient. It is our contention that this study lends support to the existing literature, as it describes the case of a 15\u2010year\u2010old female patient with a history of sickle\u2010cell disease who presented with a fever and vomiting, rapid development of sleepiness, consciousness disturbances, medium mydriasis, neck stiffness, and trismus with seizure. Her Glasgow Coma Scale (GCS) score was 5. Laboratory tests revealed an increase in creatinine, metabolic acidosis, hyperammonemia, high cerebrospinal fluid (CSF) glutamine levels, alterations in coagulation and in liver function, rising inflammatory markers, cerebral oedema on brain Computerized Tomography (CT) scan, 10^6 copies\/ml of Methicillin\u2010Resistant <jats:styled-content style=\"fixed-case\"><jats:italic>Staphylococcus Aureus<\/jats:italic><\/jats:styled-content> (MRSA) in pulmonary swab film array, and elevated DFR blood level. The treatment plan involved the early cessation of DFR, the correction of acidosis, mechanical ventilation, mannitol and bioarginine, vasoactive drug, antibiotics, and supportive care with continuous veno\u2010venous hemodiafiltration (CVVHDF) for hyperammonemia and therapeutic plasma exchange (TPE) for a high CSF glutamine level resulting from cytotoxic encephalopathy. The patient successfully overcame the multiorgan failure, with no permanent neurologic complications. It is our opinion that healthcare providers and family caregivers of patients with chronic disease may be particularly attuned to the emergence of any sign or symptom, and thus well positioned to take prompt action to avert life\u2010threatening clinical deterioration due to rising DFR levels. It is recommended that critical care providers commence extracorporeal blood purification therapies (EBPT) at the earliest opportunity, taking care to adapt the technique to the specific needs of the patient and to avoid the potential for fatal neurological complications.<\/jats:p>","DOI":"10.1002\/jca.70032","type":"journal-article","created":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T04:34:03Z","timestamp":1747974843000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Extracorporeal Blood Purification Therapy to Deal a Deferasirox Induced Life\u2010Threatening Hepatic Encephalopathy in a Septic Child With Sickle\u2010Cell Disease: A Case Report"],"prefix":"10.1002","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4897-4579","authenticated-orcid":false,"given":"E.","family":"Rossetti","sequence":"first","affiliation":[{"name":"Pediatric Intensive Care Unit, Anaesthesia and Intensive Care Division Bambino Ges\u00f9 Children's Hospital, IRCCS  Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Cappoli","sequence":"additional","affiliation":[{"name":"Unit of Nephrology and Dialysis, Division of Pediatric Subspecialties Bambino Ges\u00f9 Children's Hospital, IRCCS  Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R.","family":"Labbadia","sequence":"additional","affiliation":[{"name":"Unit of Nephrology and Dialysis, Division of Pediatric Subspecialties Bambino Ges\u00f9 Children's Hospital, IRCCS  Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G.","family":"Leone","sequence":"additional","affiliation":[{"name":"Unit of Transfusion Medicine, Division of Diagnostic and Laboratory Medicine Bambino Ges\u00f9 Children's Hospital, IRCCS  Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"F.","family":"Chiusolo","sequence":"additional","affiliation":[{"name":"Pediatric Intensive Care Unit, Anaesthesia and Intensive Care Division Bambino Ges\u00f9 Children's Hospital, IRCCS  Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"F.","family":"Tortora","sequence":"additional","affiliation":[{"name":"Pediatric Intensive Care Unit, Anaesthesia and Intensive Care Division Bambino Ges\u00f9 Children's Hospital, IRCCS  Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D.","family":"Martinelli","sequence":"additional","affiliation":[{"name":"Division of Metabolism Bambino Ges\u00f9 Children's Hospital, IRCCS  Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"Marano","sequence":"additional","affiliation":[{"name":"Area Rossa Division Pediatric Poison Control Center, Bambino Ges\u00f9 Children's Hospital, IRCCS  Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,5,22]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.18770"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccr3.1040"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1159\/000504559"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00467\u2010021\u201005289\u20100"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPH.0000000000000654"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10571\u2010021\u201001156\u20106"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1080\/15563650.2018.152342"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood\u20102009\u201005\u2010222729"},{"volume-title":"Jadenu(deferasirox)","year":"2020","key":"e_1_2_7_10_1"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnins.2021.578922"}],"container-title":["Journal 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