Whole blood immunoadsorption of anti-A or anti-B antibodies.

Immunoadsorption columns capable of specifically removing antibodies show promise as an alternative treatment to plasma exchange. Most columns are designed to be perfused with plasma and it is necessary to use a plasma separation device (filtration or centrifugation) for the procedure. This increases the cost and complexity of the immunoadsorption procedure. We have adapted immunoadsorption columns capable of removing anti-A or anti-B red cell antibody from plasma to a whole blood perfusion system by coating the silica with a thin layer of collodion and incubating with albumin (1%). Patients were given heparin, 25 units/kg intravenously, followed by a continuous infusion of 3% citrate and heparin, 10 units/ml, to achieve a ratio of 1:16-1:20 (anticoagulant to whole blood) before delivery through the columns. Effective and specific removal of anti-A or anti-B antibody was achieved with this technique. Effects on coagulation parameters and the complement system were acceptably small.