{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T10:10:23Z","timestamp":1756289423680,"version":"3.44.0"},"reference-count":13,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2017,7,26]]},"abstract":"<jats:p>Patients with homozygous familial hypercholesterolaemia are optimally treated with low-density lipoprotein apheresis. Young patients who do not meet a weight threshold (25\u2009kg) receive regular plasmapheresis. This approach may remove excessive immunoglobulins and vascular access set-up can be challenging. We report the case of a 4\u2009year-old child who exhibited repeated septic infections (5 in 6 months) and had recurrent access issues before two interventions were implemented: (1) the percutaneous central venous line was modified to two implanted paediatric ports, and (2) the patient started receiving two bags of Octaplasma at the end of each plasmapheresis treatment to account for the excessive loss of immunoglobulins. For the paediatric plasmapheresis access port, a 19-gauge Huber needle had to be used for the arterial port to prevent the collapse of the extension. These two simple changes have left the patient infection-free for 9 months.<\/jats:p>","DOI":"10.1136\/bcr-2017-219538","type":"journal-article","created":{"date-parts":[[2017,9,2]],"date-time":"2017-09-02T02:30:12Z","timestamp":1504319412000},"page":"bcr-2017-219538","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Strategies to reduce line infections in a small child with homozygous familial hypercholesterolaemia who cannot yet receive LDL apheresis"],"prefix":"10.1136","volume":"2017","author":[{"given":"Misan","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Paediatrics, University of Western Ontario, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janet","family":"Barr","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, University of Western Ontario, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stewart","family":"Kribs","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of Western Ontario, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guido","family":"Filler","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, University of Western Ontario, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2017,9,1]]},"reference":[{"key":"2025082702385122000_2017.sep01_2.bcr-2017-219538.1","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.pcad.2016.07.006","article-title":"Familial Hypercholesterolemia: Advances in Recognition and Therapy","volume":"59","author":"Cartier","year":"2016","journal-title":"Prog Cardiovasc Dis"},{"key":"2025082702385122000_2017.sep01_2.bcr-2017-219538.2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehv157"},{"key":"2025082702385122000_2017.sep01_2.bcr-2017-219538.3","first-page":"731","article-title":"Natural history and cardiac manifestations of homozygous familial hypercholesterolaemia","volume":"76","author":"Haitas","year":"1990","journal-title":"Q J Med"},{"key":"2025082702385122000_2017.sep01_2.bcr-2017-219538.4","first-page":"32","article-title":"Familial hypercholesterolemia: Review of diagnosis, screening, and treatment","volume":"62","author":"Turgeon","year":"2016","journal-title":"Can Fam physician M\u00e9decin Fam Can"},{"key":"2025082702385122000_2017.sep01_2.bcr-2017-219538.5","first-page":"144","article-title":"Stenotrophomonas maltophilia bacteremia in pediatric patients-- a 10-year analysis","volume":"39","author":"Wu","year":"2006","journal-title":"J Microbiol Immunol Infect"},{"key":"2025082702385122000_2017.sep01_2.bcr-2017-219538.6","unstructured":"Ontario Health Technology Advisory Committee, OHTAC Recommendation: Low-Density Lipoprotein Apheresis. 2007 http:\/\/www.hqontario.ca\/english\/providers\/program\/ohtac\/tech\/recommend\/rec_ldl_20071122.pdf (accessed 29 Aug 2017)."},{"key":"2025082702385122000_2017.sep01_2.bcr-2017-219538.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2013.11.025"},{"key":"2025082702385122000_2017.sep01_2.bcr-2017-219538.8","doi-asserted-by":"crossref","unstructured":"Carter JH , Langley JM , Kuhle S , et al . 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