title: Severe Hemolysis in a Patient With Erythrocytosis During Coupled Plasma Filtration Adsorption Therapy Was Prevented by Changing From Membrane-Based Technique to a Centrifuge-Based One.
abstract: Coupled plasma filtration adsorption (CPFA) usually adopts membrane to separate plasma from blood. Here, we reported a case with erythrocytosis experienced severe hemolysis and membrane rupture during CPFA, which was avoided by changing from membrane-based technique to a centrifuge-based one. A 66-year-old man was to receive CPFA for severe hyperbilirubinemia (total bilirubin 922 μmol/L, direct bilirubin 638 μmol/L) caused by obstruction of biliary tract. He had erythrocytosis (hemoglobin 230 g/L, hematocrit 0.634) for years because of untreated tetralogy of Fallot. Severe hemolysis and membrane rupture occurred immediately after blood entering into the plasma separator even at a low flow rate (50 mL/min) and persisted after changing a new separator. Finally, centrifugal plasma separation technique was used for CPFA in this patient, and no hemolysis occurred. After 3 sessions of CPFA, total bilirubin level decreased to 199 μmol/L with an average decline by 35% per session. Thereafter, the patient received endoscopic biliary stent implantation, and total bilirubin level returned to nearly normal. Therefore, centrifugal-based plasma separation can also be used in CPFA and may be superior to a membrane-based one in patients with hyperviscosity.
authors.affiliation: National Clinical Research Center of Kidney Disease, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
authors.forename: Rong
authors.initials: R
authors.lastname: Fan
authors.forename: Buyun
authors.initials: B
authors.lastname: Wu
authors.forename: Ling
authors.initials: L
authors.lastname: Kong
authors.forename: Dehua
authors.initials: D
authors.lastname: Gong
mesh_terms: D000368:Aged; D002498:Centrifugation; D006461:Hemolysis / Q000502:physiology*; D006801:Humans; D006932:Hyperbilirubinemia / Q000628:therapy; D008297:Male; D010956:Plasmapheresis / Q000009:adverse effects*; D011086:Polycythemia / Q000209:etiology / Q000628:therapy*