High cut-off membrane for in-vivo dialysis of free plasma hemoglobin in a patient with massive hemolysis.
BMC Nephrol
; 19(1): 250, 2018 10 04.
Article
em En
| MEDLINE
| ID: mdl-30286730
ABSTRACT
BACKGROUND:
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 αß dimers (31.3 kDa), the form in which the α2ß2 hemoglobin tetramers (62.6 kDa) physiologically dissociate in plasma. We present herein the first reported case in which such an attempt was made. CASE PRESENTATION 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 α2ß2 tetramer poorly dissociates into the αß dimer; but increases exponentially at concentrations lower than 1 g/L.CONCLUSIONS:
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.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Diálise Renal
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Injúria Renal Aguda
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Deficiência de Glucosefosfato Desidrogenase
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Hemólise
Limite:
Humans
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Male
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Middle aged
Idioma:
En
Revista:
BMC Nephrol
Assunto da revista:
NEFROLOGIA
Ano de publicação:
2018
Tipo de documento:
Article
País de afiliação:
Espanha