Hemoperfusion

Hemoperfusion
Intervention
MeSH D006464

Hemoperfusion (British English: haemoperfusion) First introduced in the 1940s, the technique was refined during 1950 to 1970, and then introduced clinically for the treatment of poisoning in the 1970s and 1980s. It is sometimes used in drug overdose possibly in conjunction with other extracorporeal techniques such as hemodialysis(HD), peritoneal dialysis(PD), hemofiltration(HF), and hemodiafiltration(HDF).[1]

The US Food and Drug Administration(FDA) defines sorbent hemoperfusion as follows:

″(a) Identification. A sorbent hemoperfusion system is a prescription device that consists of an extracorporeal blood system similar to that identified in the hemodialysis system and accessories (876.5820) and a container filled with adsorbent material that removes a wide range of substances, both toxic and normal, from blood flowing through it. The adsorbent materials are usually activated-carbon or resins which may be coated or immobilized to prevent fine particles entering the patient's blood. The generic type of device may include lines and filters specifically designed to connect the device to the extracorporeal blood system. The device is used in the treatment of poisoning, drug overdose, hepatic coma, or metabolic disturbances.″ [2]

Two types of hemoperfusion are commonly used:

1) Charcoal hemoperfusion, which has been used to treat liver (hepatic) failure, various types of poisoning, and certain autoimmune diseases when coated with antigens or antibodies.

2) Certain resins(Polystyrene - XAD series) are frequently more efficient at clearing lipid soluble drugs than charcoal hemoperfusion.

Hemoperfusion is also used in the treatment of specific intoxications, such as valproic acid, theophylline, and meprobamate.

[3][4]

Despite its availability, this technique is only infrequently utilized as a medical process used to remove toxic substances from a patient's blood.[5]

Complications

Complications of hemoperfusion may include thrombocytopenia, leucopenia, hypoglycemia, and some reduction in clotting factors, with recovery typically occuring in 1-2 days. Risk of bleeding is also higher because of high heparin dose and reduction in platelets and clotting factors.[6]

Indications for Use

During hemoperfusion, the blood passes through a column with absorptive properties aiming at removing specific toxic substances from the patient’s blood. It especially targets small- to medium-sized molecules that tend to be more difficult to remove by conventional hemodialysis. The adsorbent substance most commonly used in hemoperfusion are resins and activated carbon.[7] Hemoperfusion is an extracorporeal form of treatment because the blood is pumped through a device outside the patient's body.

Its major uses include removing drugs or poisons from the blood in emergency situations, removing waste products from the blood in patients with kidney failure, and as a supportive treatment for patients before and after liver transplantation.[8]

References

  1. ↑ Manual of Clinical Dialysis, Second Edition, Ch. 16.2, pp. 229-232 Springer, Suhail Ahmad, University of Washington, Scribner Kidney Center, Northwest Kidney Centers, Seattle, Washington, USA
  2. ↑ http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/cfrsearch.cfm?fr=876.5870 Code of Federal Regulations (CFR); Title 21, Volume 8; Revised as of April 1, 2014; CITE: 21CFR876.5870 See Related Information on Sorbent hemoperfusion system. in CDRH databases TITLE 21--FOOD AND DRUGS CHAPTER I--FOOD AND DRUG ADMINISTRATION DEPARTMENT OF HEALTH AND HUMAN SERVICES SUBCHAPTER H--MEDICAL DEVICES PART 876 -- GASTROENTEROLOGY-UROLOGY DEVICES Subpart F--Therapeutic Devices Sec. 876.5870 Sorbent hemoperfusion system.
  3. ↑ Manual of Clinical Dialysis, Second Edition, Ch. 16.2.3, pp.229-232 Springer, Suhail Ahmad, University of Washington, Scribner Kidney Center, Northwest Kidney Centers, Seattle, Washington, USA
  4. ↑ http://cursoenarm.net/UPTODATE/contents/mobipreview.htm?10/53/11102
  5. ↑ http://www.uptodate.com/contents/hemoperfusion
  6. ↑ Manual of Clinical Dialysis, Second Edition, Ch. 16.2.3.2, pp.231-232 Springer, Suhail Ahmad, University of Washington, Scribner Kidney Center, Northwest Kidney Centers, Seattle, Washington, USA
  7. ↑ Rahman MH, Haqqie SS, McGoldrick MD (2006). "Acute hemolysis with acute renal failure in a patient with valproic acid poisoning treated with charcoal hemoperfusion". Hemodialysis international. International Symposium on Home Hemodialysis 10 (3): 256–9. doi:10.1111/j.1542-4758.2006.00105.x. PMID 16805886.
  8. ↑ http://www.gambro.com/en/global/Therapies/Hemoperfusion1/