Meijers B K I, Verhamme P, Nevens F, Hoylaerts M F, Bammens B, Wilmer A, Arnout J, Vanrenterghem Y, Evenepoel P
Department of Medicine, Division of Nephrology, University Hospital Leuven, Leuven, Belgium.
Am J Transplant. 2007 Sep;7(9):2195-9. doi: 10.1111/j.1600-6143.2007.01909.x. Epub 2007 Jul 19.
Fractionated Plasma Separation and Adsorption (FPSA) is a novel nonbiologic detoxification system for the removal of protein-bound solutes. FPSA is used to bridge patients during fulminant liver failure, either to functional recovery or to liver transplantation. Besides liver failure associated protein bound solutes, several important uremic retention solutes share important protein binding. We observed repeated occlusive thrombosis of the arterio-venous conduit during FPSA in hemodialysis (HD) patients, resulting in acute loss of function. A major reduction of several coagulation factors was demonstrated, exceeding 50% for factor II, factor X and protein C. Broad disturbances of the coagulation system were confirmed in FPSA treated liver failure patients. An ex vivo recirculation model demonstrated nonspecific adsorption of coagulation factors protein S and protein C on the anion exchange cartridge. Direct contact between fractionated plasma and the Prometh02 anion exchanger causes significant adsorption of procoagulant and anti-coagulant factors, associated with clinically relevant adverse events.
分步血浆分离吸附（FPSA）是一种用于去除蛋白结合溶质的新型非生物解毒系统。FPSA用于在暴发性肝衰竭期间为患者提供过渡，直至其功能恢复或进行肝移植。除了与肝衰竭相关的蛋白结合溶质外，几种重要的尿毒症潴留溶质也具有重要的蛋白结合特性。我们观察到血液透析（HD）患者在进行FPSA时动静脉导管反复发生闭塞性血栓形成，导致功能急性丧失。结果显示几种凝血因子大幅减少，其中因子II、因子X和蛋白C减少超过50%。在接受FPSA治疗的肝衰竭患者中证实了凝血系统存在广泛紊乱。体外再循环模型表明凝血因子蛋白S和蛋白C在阴离子交换柱上存在非特异性吸附。分步血浆与Prometh02阴离子交换器直接接触会导致促凝血因子和抗凝血因子大量吸附，从而引发具有临床相关性的不良事件。
