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Hadid S, Raval JS. Utilizing triple tandem extracorporeal membrane oxygenation, therapeutic plasma exchange, and continuous renal replacement therapy in a neonate with elevated plasma-free hemoglobin. Ther Apher Dial 2024; 28:472-474. [PMID: 38409916 DOI: 10.1111/1744-9987.14110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/12/2024] [Accepted: 01/30/2024] [Indexed: 02/28/2024]
Affiliation(s)
- Senan Hadid
- Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Jay S Raval
- Department of Pathology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
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Douglas CE, House TR, Yalon L, Menon S. Therapeutic plasma exchange for mechanical red cell hemolysis: A case series. J Clin Apher 2024; 39:e22093. [PMID: 37850483 PMCID: PMC10922221 DOI: 10.1002/jca.22093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/22/2023] [Accepted: 10/06/2023] [Indexed: 10/19/2023]
Abstract
We present three cases of severely elevated plasma free hemoglobin (PFH) in pediatric patients on mechanical circulatory support devices at a tertiary pediatric care center. Due to severe levels of PFH in the setting of critical illness with the inability to pursue immediate mechanical device exchange, membrane filtration therapeutic plasma exchange (TPE) was performed, which resulted in a lowering of PFH levels. However, long-term outcomes were heterogeneous across the cases. This case series reviews patient presentation, organ function before and after TPE, and the overall role of TPE as an effective treatment option to decrease severely elevated PFH levels. In doing so, we hope to add to what is known about the use of TPE for mechanical red cell hemolysis and provide guidance on its use in critically ill patients.
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Affiliation(s)
- Chloe E. Douglas
- Division of Nephrology, Seattle Children’s Hospital, Seattle, Washington, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Taylor R. House
- Division of Nephrology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Larissa Yalon
- Division of Nephrology, Seattle Children’s Hospital, Seattle, Washington, USA
| | - Shina Menon
- Division of Nephrology, Seattle Children’s Hospital, Seattle, Washington, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
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Han X, Zhang Q, Xia F, Zhang Y, Wang W. Exploration of risk factors for hemoglobinuria and acute kidney injury following iliofemoral venous mechanical thrombectomy. J Interv Med 2023; 6:24-28. [PMID: 37180365 PMCID: PMC10167515 DOI: 10.1016/j.jimed.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 10/15/2022] [Accepted: 10/31/2022] [Indexed: 11/11/2022] Open
Abstract
Objective To evaluate the risk factors for hemoglobinuria and acute kidney injury (AKI) after percutaneous mechanical thrombectomy (MT) with or without catheter-directed thrombolysis (CDT) for iliofemoral deep vein thrombosis (IFDVT). Methods Patients with IFDVT who had MT with the AngioJet catheter (group A), MT plus CDT (group B), or CDT alone (group C) from January 2016 to March 2020 were retrospectively evaluated. Hemoglobinuria was monitored throughout the treatment course, and postoperative AKI was assessed by comparing the preoperative (baseline) and postoperative serum creatinine (sCr) levels from the electronic medical records of all patients. AKI was defined as an elevation in the sCr level exceeding 26.5 μmol/L within 72 h after the operation according to the Kidney Disease Improving Global Outcomes criteria. Results A total of 493 consecutive patients with IFDVT were reviewed, of which 382 (mean age, 56 ± 11 years; 41% of them were females; 97 in group A, 128 in group B, and 157 in group C) were finally analyzed. Macroscopic hemoglobinuria was evident in 44.89% of the patients of the MT groups (101/225, 39 in group A, and 62 in group B), with no significant difference between the groups (P = 0.219), but not in the patients in group C. None of the patients developed AKI (mean sCr difference -2.76 ± 13.80 μmol/L, range = -80.20 to 20.60 μmol/L) within 72 h after surgery. Conclusions Rheolytic MT is an independent risk factor for hemoglobinuria. A proper aspiration strategy, hydration, and alkalization following thrombectomy are particularly favorable for preventing AKI.
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Affiliation(s)
- Xinqiang Han
- Department of Interventional Medicine and Vascular, Binzhou Medical University Hospital, Binzhou, 256603, Shandong, China
| | - Qingqing Zhang
- Department of Cerebrovascular, Binzhou Medical University Hospital, Binzhou, 256603, Shandong, China
| | - Fengfei Xia
- Department of Interventional Medicine and Vascular, Binzhou Peoples Hospital, Binzhou, 256600, Shandong, China
| | - Yongzhen Zhang
- Department of Interventional Medicine and Vascular, Binzhou Medical University Hospital, Binzhou, 256603, Shandong, China
| | - Wenming Wang
- Department of Interventional Medicine and Vascular, Binzhou Medical University Hospital, Binzhou, 256603, Shandong, China
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Butragueño Laiseca L, Estepa Pedregosa L, Sánchez Galindo AC, Santiago Lozano MJ. Hemolysis and methemoglobinemia in a child with left ventricular assist Levitronix PediMag. Int J Artif Organs 2020; 44:68-71. [PMID: 32552341 DOI: 10.1177/0391398820932175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 5-month-old male was treated with left ventricular assist device due to cardiac failure secondary to dilated cardiomyopathy. The patient developed acute severe intravascular hemolysis with methemoglobinemia and renal failure, related to a mechanical problem due to pump cylinder misalignment. Secondary severe methemoglobinemia has not been previously described in patients undergoing ventricular assist device. Early detection of the signs and symptoms of hemolysis is crucial to prevent further complications.
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Affiliation(s)
- Laura Butragueño Laiseca
- Department of Pediatric Intensive Care, Hospital General Universitario Gregorio Marañon, Madrid, Spain
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Abstract
Cardiopulmonary bypass (CPB) induces hemolysis, which manifests as plasma free hemoglobin. We investigated in a post hoc analysis of a single-center, blinded, controlled study whether the use of a novel hemoadsorption device (CytoSorb, CytoSorbents Europe GmbH, Berlin, Germany) affects hemolysis during CPB. A total of 35 patients undergoing elective CPB surgery with an expected CPB duration of more than 120 min were included in the analysis. The hemoadsorption device was used in 17 patients (intervention group) and not used in 18 patients (control group). The primary outcome was differences of postoperative free hemoglobin and haptoglobin levels. As secondary outcomes, we investigated differences in postoperative lactate dehydrogenase and bilirubin levels. Postoperative free hemoglobin levels were not significantly different between the groups. However, there were statistically significant differences between the treatment and control groups in the median levels of haptoglobin (58.4 vs. 17.9 mg/dL, respectively; P < 0.01) and lactate dehydrogenase (353.0 vs. 432.0 U/L, respectively; P < 0.05) on postoperative day 1. Thus, in this study, we did not find an effect on hemolysis in patients treated with hemoadsorption, though lower haptoglobin level and higher secondary hemolysis markers on postoperative day 1 in patients not treated with the hemoadsorber may be an indication of some moderate effect of the device. Studies with larger samples are needed to clarify the significance of the small differences detected in this study.
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Cucchiari D, Reverter E, Blasco M, Molina-Andujar A, Carpio A, Sanz M, Escorsell A, Fernández J, Poch E. High cut-off membrane for in-vivo dialysis of free plasma hemoglobin in a patient with massive hemolysis. BMC Nephrol 2018; 19:250. [PMID: 30286730 PMCID: PMC6172805 DOI: 10.1186/s12882-018-1051-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 09/20/2018] [Indexed: 11/10/2022] Open
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 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. 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 α2β2 tetramer poorly dissociates into the αβ 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.
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Affiliation(s)
- David Cucchiari
- Nephrology and Renal Transplant Unit, Hospital Clínic, Carrer Villaroel 170, 08036, Barcelona, Spain.
| | - Enric Reverter
- Liver Intensive Care Unit, Hepatology. Hospital Clínic, Barcelona, Spain
| | - Miquel Blasco
- Nephrology and Renal Transplant Unit, Hospital Clínic, Carrer Villaroel 170, 08036, Barcelona, Spain
| | - Alicia Molina-Andujar
- Nephrology and Renal Transplant Unit, Hospital Clínic, Carrer Villaroel 170, 08036, Barcelona, Spain
| | - Adriá Carpio
- Liver Intensive Care Unit, Hepatology. Hospital Clínic, Barcelona, Spain
| | - Miquel Sanz
- Liver Intensive Care Unit, Hepatology. Hospital Clínic, Barcelona, Spain
| | - Angels Escorsell
- Liver Intensive Care Unit, Hepatology. Hospital Clínic, Barcelona, Spain
| | - Javier Fernández
- Liver Intensive Care Unit, Hepatology. Hospital Clínic, Barcelona, Spain
| | - Esteban Poch
- Nephrology and Renal Transplant Unit, Hospital Clínic, Carrer Villaroel 170, 08036, Barcelona, Spain
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Kubota K, Egi M, Mizobuchi S. Haptoglobin Administration in Cardiovascular Surgery Patients. Anesth Analg 2017; 124:1771-1776. [DOI: 10.1213/ane.0000000000002093] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Hayes C, Shafi H, Mason H, Klapper E. Successful reduction of plasma free-hemoglobin using therapeutic plasma exchange: A case report. Transfus Apher Sci 2016; 54:253-5. [DOI: 10.1016/j.transci.2015.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 08/21/2015] [Accepted: 08/25/2015] [Indexed: 11/28/2022]
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Bell R, Hanif F, Prasad P, Ahmad N. Red Kidney: Kidney Transplant From a Deceased Donor Who Received Massive Blood Transfusion During Cardiopulmonary Bypass. EXP CLIN TRANSPLANT 2015; 14:341-4. [PMID: 26030717 DOI: 10.6002/ect.2014.0129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Here, we present a case of a deceased-donor kidney transplant. The brain-dead donor had received a massive blood transfusion during cardiopulmonary bypass, which lead to hemolysis, hemoglobinuria, acute kidney injury, and renal replacement therapy. The kidney appeared red after in situ flush. Postoperatively, the recipient developed delayed graft function. Protocol biopsy during the postoperative period revealed the widespread deposition of heme pigment in the renal tubules. Massive blood transfusion and cardiopulmonary bypass surgery are associated with hemolysis and heme pigment deposition in the renal tubules, which subsequently lead to acute kidney injury. Kidneys from such donors appear red and, while this does not preclude transplant, are likely to develop delayed graft function.
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Affiliation(s)
- Richard Bell
- From the Division of Surgery, Department of Transplantation, St James' University Hospital, Leeds and United Kingdom
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Durandy Y, Wang S, Ündar A. An Original Versatile Nonocclusive Pressure-Regulated Blood Roller Pump for Extracorporeal Perfusion. Artif Organs 2013; 38:469-73. [DOI: 10.1111/aor.12192] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Yves Durandy
- Intensive Care Department; Pediatric Cardiac Surgery CCML; Le Plessis-Robinson France
| | - Shigang Wang
- Penn State Hershey Pediatric Cardiovascular Research Center; Departments of Pediatrics, Surgery and Bioengineering; Penn State Milton S. Hershey Medical Center; Penn State Hershey College of Medicine; Penn State Hershey Children's Hospital; Hershey PA USA
| | - Akif Ündar
- Penn State Hershey Pediatric Cardiovascular Research Center; Departments of Pediatrics, Surgery and Bioengineering; Penn State Milton S. Hershey Medical Center; Penn State Hershey College of Medicine; Penn State Hershey Children's Hospital; Hershey PA USA
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