title: Successful reduction of plasma free-hemoglobin using therapeutic plasma exchange: A case report.
abstract: Massive intravascular hemolysis may overwhelm hemoglobin (Hgb) clearance mechanisms leading to accumulation of excess plasma free-Hgb and subsequent acute kidney injury. We present the case of a 44-year-old male with cardiac failure necessitating placement of a subcutaneous left ventricular assist device. Following insertion, the patient developed mechanical hemolysis and an acute decline in renal function. Three therapeutic plasma exchange procedures were performed resulting in a dramatic decrease in plasma free-Hgb levels and stabilization of renal function. This demonstrates that therapeutic plasma exchange can be used to decrease plasma free-Hgb in cases of intravascular hemolysis, possibly protecting the patient from hemoglobinuric acute kidney injury.
authors.affiliation: Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Electronic address: chelsea.hayes@cshs.org.
authors.forename: Chelsea
authors.initials: C
authors.lastname: Hayes
authors.affiliation: Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Hedyeh
authors.initials: H
authors.lastname: Shafi
authors.affiliation: Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Holli
authors.initials: H
authors.lastname: Mason
authors.affiliation: Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Ellen
authors.initials: E
authors.lastname: Klapper
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000628:therapy*; D000328:Adult; D006454:Hemoglobins; D006456:Hemoglobinuria / Q000097:blood / Q000628:therapy*; D006461:Hemolysis; D006801:Humans; D008297:Male; D010951:Plasma Exchange
chemical_list: D006454:Hemoglobins
keywords: Hemoglobinuric acute kidney injury; Mechanical hemolysis; Plasma exchange; Plasma free-Hgb; Plasmapheresis