Plasmapheresis in newborns with hyperbilirubinemia.

With a miniaturized plasmapheresis system consisting of a double head pump and balancing pump, extracorporeal detoxification treatments such as plasmapheresis, hemofiltration, and hemodialysis were carried out. In total 15 premature infants and newborns with Rherythroblastosis and hyperbilirubinemia were treated using this miniaturized system. The average birth weight of the 15 patients was 2,386 g. With a main blood flow of 5.3 ml/min and a filtrate flow of 1.3 ml/min, an average of 192.4 ml of plasma per treatment was exchanged. In all patients 1 to 10 plasmapheresis treatments were necessary to reduce the mean serum bilirubin from 15.6 +/- 4.8 to 7.3 +/- 3.2 mg/dl, and after several days the serum bilirubin subsequently normalized in 12 patients, who improved. Three patients died 5 to 18 days after birth as a result of their primary disease and immaturity. For vascular access small catheters were inserted in the umbilical or the femoral vein. All treatments were well tolerated by the patients.

Ultrafiltration of dialysis fluid for hemodialysis.

Since the quality of water in dialysis fluid varies considerably, and, in view of the fact that endotoxin or active derivatives can cause acute side effects in patients, the dialysis fluid must be sterile. The predialyzer fluid in 20 hemodialysis patients was investigated. Bacterial loading was between 5/ml and 5,000/ml, and the endotoxin concentration was high and extremely variable. After ultrafiltration of the dialysis fluid by a polyamide hollow fiber membrane, all samples were free of bacteria, and the concentration of endotoxin was lower than the detectable limit. With this procedure we can obtain sterile dialysis fluid, which is endotoxin free.

[Behavior of oxypolygelatine (Gelifundol) in patients with dialysis-dependent kidney failure]. / Verhalten von Oxypolygelatine (Gelifundol) bei Patienten mit dialysepflichtiger Niereninsuffizienz.

Colloidal solutions are used with increasing frequency as plasma replacement, in addition to thrombosis prophylaxis, for treating disturbances of the microcirculation and hemodilution as well as for cases of decreases in blood pressure during hemodialysis and hemofiltration treatments. The effects of the dextran, hydroxyethyl amylum and gelatine preparations available very greatly, for example with regard to expander effect, half life, elimination etc. Gelatine solutions have a particularly short intravascular retention and therefore appeared to us to be especially suitable for treating decreases in blood pressure and states of shock during hemodialysis and hemofiltration. We examined the behaviour of 5,5% oxypolygelatine (OPG) in 11 patients during dialysis treatment (6 patients with a residual diuresis smaller than 500 ml/24 h, 5 patients with a residual diuresis larger than 500 ml/24 h). Before each of the 12 treatments 250 ml OPG was administered to all patients. 48 hours later 86-93% of the infused OPG had been eliminated. Despite repeated doses no remarkable OPG cumulation was registered.