Cucchiari David, Reverter Enric, Blasco Miquel, Molina-Andujar Alicia, Carpio Adriá, Sanz Miquel, Escorsell Angels, Fernández Javier, Poch Esteban
Nephrology and Renal Transplant Unit, Hospital Clínic, Carrer Villaroel 170, 08036, Barcelona, Spain.
Liver Intensive Care Unit, Hepatology. Hospital Clínic, Barcelona, Spain.
BMC Nephrol. 2018 Oct 4;19(1):250. doi: 10.1186/s12882-018-1051-x.
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.
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.
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.
从人血浆中清除游离血浆血红蛋白（CPH）的可能性似乎很有吸引力，尤其是考虑到CPH对免疫功能的有害影响及其滤过导致的肾损伤时。所谓的高通量（HCO）滤器的存在，其孔径高达60 kDa，可能潜在地允许清除αβ二聚体（31.3 kDa），α2β2血红蛋白四聚体（62.6 kDa）在血浆中生理解离的形式。我们在此报告首例进行此类尝试的病例。
患者为一名51岁男性，因葡萄糖-6-磷酸脱氢酶缺乏导致溶血危象，并伴有色素性肾病。他接受了48小时的连续性静脉-静脉血液滤过透析（CVVHD）治疗，期间使用了HCO滤器。CPH的筛系数（SC）最初为0.08，24小时后降至0.02。这种意外的低SC是由于CPH的初始浓度较高（4.24 g/L）。在这样的浓度下，α2β2四聚体很难解离成αβ二聚体；但在浓度低于1 g/L时呈指数增加。
通过HCO滤器清除CPH在技术上是可行的，但其性能明显依赖于CPH的初始浓度。患有隐匿性溶血的重症患者，如在感染性休克或体外膜肺氧合（ECMO）治疗期间发生的情况，可能从使用这种膜清除CPH中获益最大。
