Sorbent therapy of the porphyrias. III. Comparative efficacy of experimental plasma perfusion with several commercial hemoperfusion cartridges.

The manifestations of the acute attack of an hepatic porphyria may result from the actions of the excessive amounts of delta-aminolevulinic acid (ALA) or porphobilinogen (PBG) that accumulate during the event. Adsorption and removal of these materials by a solid phase sorbent may be an effective rapid treatment of the attack. We have compared the rate at which 5 commercial charcoal hemoperfusion cartridges remove ALA and PBG from an in vitro system, to ascertain if any of these may be useful in the treatment of the porphyric attack. Solutions of ALA (3.0 mg/L in plasma) or PBG (1.5 mg/L in saline) were circulated from a reservoir through the cartridge and back to the reservoir. Clearances (ml/min +/- SD) of ALA or PBG were determined from their concentration in both the reservoir (kept nearly constant by periodic addition of solute) and the cartridge effluent. For ALA, clearances decreased in the order Hemosorba (118 +/- 15), two Detoxyl 2 devices in series (93 +/- 17), one Detoxyl 2 (72 +/- 16), Adsorba 300 C (52 +/- 12), Haemocol 100 (48 +/- 14) and Hemodetoxifier (46 +/- 17). Differences in ALA clearance between the Hemosorba, one or two Detoxyl 2 cartridges and all other cartridges were of high statistical significance. For PBG, clearances decreased in the order Hemosorba (1462 +/- 23), one Detoxyl 2 (719 +/- 89), Adsorba 300 C (477 +/- 131), Hemodetoxifier (376 +/- 75) and Haemocol 100 (48 +/- 13). Differences in PBG clearance among all cartridges were statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)