6 research outputs found
High cut-off membrane for in- vivo dialysis of free plasma hemoglobin in a patient with massive hemolysis
Background: 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. Case presentation: 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. Conclusions: 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
Acute liver failure due to visceral leishmaniasis in Barcelona: a case report
Background: Leishmaniasis is an emerging infectious disease. Due to human migration and tourism, visceral
leishmaniasis may become more common in non-endemic areas. In the Mediterranean basin, visceral leishmaniasis
typically occurs in rural regions.
Case presentation: We present an unusual urban case of acute liver failure due to visceral leishmaniasis, following
a prolonged fever of unknown origin. After obtaining negative results from the bone marrow aspirate, we
performed a liver biopsy that elucidated the diagnosis. The liver involvement in visceral leishmaniasis may appear
as chronic granulomatous hepatitis. However diffuse hepatitis process, a necro-inflammatory pattern, without
forming granulomas were observed in the liver biopsy specimens in this case. Intracytoplasmic Leishmania
amastigotes were observed in the liver biopsy specimens and a polymerase chain reaction confirmed the diagnosis.
Only five pathological confirmed cases of acute hepatitis due to visceral leishmaniasis have been described so far,
just two in adults and both from Barcelona. A revision of the literature is performed.
Conclusions: Acute hepatitis is an uncommon debut of visceral leishmaniasis in immunocompetent patients.
Furthermore there are only few cases in the literature that describe the histopathological changes that we found in
this patient. In conclusion, in case of acute hepatitis leading to liver failure, leishmaniasis should be considered a
differential diagnosis (even in non-endemic countries and without clear epidemiological exposure) and liver biopsy
can elucidate the diagnosis
High cut-off membrane for in-vivo dialysis of free plasma hemoglobin in a patient with massive hemolysis
Abstract Background 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. Case presentation 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. Conclusions 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
High cut-off membrane for in- vivo dialysis of free plasma hemoglobin in a patient with massive hemolysis
Background: 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. Case presentation: 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. Conclusions: 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
Acute liver failure due to visceral leishmaniasis in Barcelona: a case report
Background: Leishmaniasis is an emerging infectious disease. Due to human migration and tourism, visceral
leishmaniasis may become more common in non-endemic areas. In the Mediterranean basin, visceral leishmaniasis
typically occurs in rural regions.
Case presentation: We present an unusual urban case of acute liver failure due to visceral leishmaniasis, following
a prolonged fever of unknown origin. After obtaining negative results from the bone marrow aspirate, we
performed a liver biopsy that elucidated the diagnosis. The liver involvement in visceral leishmaniasis may appear
as chronic granulomatous hepatitis. However diffuse hepatitis process, a necro-inflammatory pattern, without
forming granulomas were observed in the liver biopsy specimens in this case. Intracytoplasmic Leishmania
amastigotes were observed in the liver biopsy specimens and a polymerase chain reaction confirmed the diagnosis.
Only five pathological confirmed cases of acute hepatitis due to visceral leishmaniasis have been described so far,
just two in adults and both from Barcelona. A revision of the literature is performed.
Conclusions: Acute hepatitis is an uncommon debut of visceral leishmaniasis in immunocompetent patients.
Furthermore there are only few cases in the literature that describe the histopathological changes that we found in
this patient. In conclusion, in case of acute hepatitis leading to liver failure, leishmaniasis should be considered a
differential diagnosis (even in non-endemic countries and without clear epidemiological exposure) and liver biopsy
can elucidate the diagnosis