Comparison of Dialysis Efficiency Between Hemodialysis Using Heparin Bound Hemophan and Routine Hemodialysis with Systemic Heparinization / 대한신장학회잡지

Although hemodialysis using heparin bound Hemophan(HBH-HD) has been reported to be a possible modality that can be used in patients at high risk of bleeding, the efficiency of HBH-HD is not certain. To investigate the efficiency of HBH- HD, we compared the total blood compartment volume(TBCV), Kt/V and urea clearance of dialyzer(K) of HBH-HD with those of routine hemodialysis with systemic heparinization(R-HD) in the same patients. HBH-HD was switched to R-HD as soon as the bleeding risk had ceased. Before each HBH-HD, heparin solution(1liter, 20IU/ml saline) was recirculated through the Hemophan(Gambro dialyzer, GFS Plus 11) for 1 hour while removing saline solution(700ml/hr) by applying transmembrane pressure gradient, followed by a single pass rinse with 1 liter of saline solution. Then we performed 10 HBH-HD on 10 patients at risk of bleeding. The dilayzer had to be changed due to severe clotting in one patient during HBH-HD so the comparison of above parameters was possible in 9 patients. The duration of each dialysis was possible in 9 patients. The duration of each dialysis was standardized to 4 hours at blood flow of 200 to 250ml/min. During HBH-HD, there was a slight increase in activated partial thromboplastin time(aPTT)(45.02.6 sec) at 15 min after initiation of dialysis from predialysis level (35.81.3 sec), but no increase in aPTT was observed at 60min, 120min, and the end of dialyses. The loss of TBCV(%) of dialyzers was greater in HBH-HD (174%) than in R-HD(51%). The Kt/V and K of HBH-HD, however, were 1.25+/-0.10 and 143+/-3ml/ min, respectively, which did not differ from those of R-HD which were 1.28+/-0.07 and 145+/-4ml/min, respectively. We conclude that the use of heparin bound Hemophan can be an efficient hemodialysis technique in patients at high risk of bleeding, but clotting of the dialyzer should be observed carefully during hemodialysis(values are mean+/-SE).

Plasma Exchange with Cryosupernatant in the Patient with Refractory Hemolytic Uremic Syndrome / 대한신장학회잡지

Many patients with Thrombotic Thrombocytopenic Purpura-Hemolytic Uremic Syndrome(TTP-HUS) satisfactorily respond to plasma exchange. Some patients, however, respond either not at all or only transiently and incompletely. In the refractory case, endothelial cell-derived unusually large von Willebrand factor multimers(ULvWFM) have an important role in the formation of microthrombi. As the ULvWFM may be removed in the cryoprecipitate, we reason the plasma depleted of cryoprecipitate(the plasma cryosupernatant) should be considered for effectiveness in the treatment of refractory TTP- HUS. We experienced a 48 year old woman presented with diarrhea, jaundice and oliguria. She had microangiopathic hemolytic anemia, renal impairment, platelets of 21,000/mm3 and LDH 3,258U/L. She had not improved after plasma exchange with fresh frozen plasma(FFP)(1.5 plasma volumeX7 days). On hospital day 8, her HUS had not responded, platelets of 37,000/mm3 and LDH 1,588U/L. Substitution of cryosupernatant for FFP was associated with prompt increased in the platelet count to normal and complete resolution of HUS. Therefore. the cryosupernatant fraction of plasma should be considered as an alternative to whole FFP for plasma exchange if there is continuing platelet consumption and microvascular thrombosis in spite of intensive conventional plasma therapy.