High cut-off membrane for in-vivo dialysis of free plasma hemoglobin in a patient with massive hemolysis
Open Access
- 4 October 2018
- journal article
- research article
- Published by Springer Science and Business Media LLC in BMC Nephrology
- Vol. 19 (1), 1-4
- https://doi.org/10.1186/s12882-018-1051-x
Abstract
The possibility of clearing Cell-free Plasma Hemoglobin (CPH) from human plasma may appear attractive, especially when considering the noxious effects that CPH has on the immune function and the renal damage caused by its filtration. The existence of the so-called High Cut-Off (HCO) filters, possessing pores as big as 60 kDa, could potentially allow the clearance of the αβ dimers (31.3 kDa), the form in which the α2β2 hemoglobin tetramers (62.6 kDa) physiologically dissociate in plasma. We present herein the first reported case in which such an attempt was made. The patient was a 51-year-old man with hemolytic crisis due to glucose-6-phosphate dehydrogenase deficiency, further complicated by pigment-induced nephropathy. He underwent a 48-h CVVHD session, in which a HCO filter was used. The Sieving Coefficient (SC) for CPH was initially 0.08 and decreased to 0.02 after 24 h. This unexpected low SC was due to the initial high concentration of CPH (4.24 g/L). At such concentrations, the α2β2 tetramer poorly dissociates into the αβ dimer; but increases exponentially at concentrations lower than 1 g/L. Clearance of CPH through a HCO filter is technically feasible but its performance markedly relies on the initial concentration of CPH. Critically ill patients with smoldering hemolysis, as it happens during septic shock or ECMO treatment, may benefit the most from the use of this membrane in order to clear CPH.Keywords
This publication has 11 references indexed in Scilit:
- Cell-free plasma hemoglobin removal by dialyzers with various permeability profilesScientific Reports, 2015
- Plasma-Free Hemoglobin Levels in Advanced vs. Conventional Infant and Pediatric Extracorporeal Life Support Circuits2013
- Hemolysis‐induced acute kidney injury following cardiac surgery: A case report and review of the literatureHemodialysis International, 2012
- Free hemoglobin concentration in severe sepsis: methods of measurement and prediction of outcomeCritical Care, 2012
- Hemodialysis Membrane With a High-Molecular-Weight Cutoff and Cytokine Levels in Sepsis Complicated by Acute Renal Failure: A Phase 1 Randomized TrialAmerican Journal of Kidney Diseases, 2007
- Pilot study on the effects of high cutoff hemofiltration on the need for norepinephrine in septic patients with acute renal failure*Critical Care Medicine, 2006
- High permeability haemofiltration improves peripheral blood mononuclear cell proliferation in septic patients with acute renal failureNephrology Dialysis Transplantation, 2003
- TNF- elimination with high cut-off haemofilters: a feasible clinical modality for septic patients?Nephrology Dialysis Transplantation, 2003
- Hemoglobin infusion augments the tumor necrosis factor response to bacterial endotoxin (lipopolysaccharide) in miceCritical Care Medicine, 1999
- HYPOPHYSECTOMY, HIGH TUMOR NECROSIS FACTOR LEVELS, AND HEMOGLOBINEMIA IN LETHAL ENDOTOXEMIC SHOCKShock, 1998