Hemoperfusion--state of art.

The authors make a general review of the state of art in HP with particular reference to the history, the main field of application, and the development of specific and selective sorbents. In this text, attention is paid to the application in the immunological field comparing the therapeutical removal of toxins with different sorbents. Next, the authors describe their experimental study with hemoperfusion using coated anion exchange resins for the treatment of acute respiratory insufficiency, the correction of metabolic alkalosis in pyloric stenosis, the removal of a high dosage of antiblastic agent in conjunction with the study of heparin subtraction by coated resins and finally the development of a particular type of resin for phosphates removal in uremia. These different fields of research recognize the necessity to look for a selective exchange by hemoperfusion because the concept of the "magic filter" that removes everything is not scientifically acceptable. Some explanations are given for the behaviour of the strong anion exchange resins regarding simple or complex ions and the influence of the chemical composition of the matrix. In conclusion, the authors underline that selective removal by HP is actually underutilized considering its potency.