Hemoperfusion through albumin-conjugated agarose gel for the treatment of neonatal jaundice in premature rhesus monkeys.

Hemoperfusion through albumin-conjugated agarose gel (AAG) effectively removes bilirubin (BR) and other albumin-bound materials from whole blood or plasma. We have used this technique to treat neonatal jaundice in premature rhesus monkeys with a specially designated apparatus which permits continuous perfusion through one of four columns arranged in parallel while the others are sequentially washed with saline and regenerated with ethanol. Less than 15 per cent of the animal's blood volume is required in the extracorporeal circuit at any time. Results indicate that (1) compared with five control monkeys which had a peak BR concentration ([BR]) averaging approximately 4 mg./100 ml., six experimental monkeys showed a significant (p less than 0.01) reduction, averaging 60 per cent, in [BR] after each of two perfusions at approximately 20 and 26 hours of age; (2) AAG hemoperfusion was even more effective in lowering [BR] in monkeys with higher preperfusion concentrations produced by BR infusion (average reduction = 68 and 87 per cent at preperfusion concentrations of 11.9 and 24.2 mg./100 ml., respectively); and (3) overall, BR eluted from the column averaged 93 per cent of the estimated preperfusion plasma BR pool. Unlike previous studies in rats, perfused monkeys showed significant platelet losses, although it was possible to prevent these losses by the use of "regional citrate" during perfusion. These studies suggest that AAG hemoperfusion is effective in the treatment of neonatal jaundice, although potential problems such as sterility and platelet loss need further evaluation before it can be considered for human use.