A 27‑year‑old primigravida at 26 weeks’ age of gestation presented with difficulty of breathing, nonproductive cough, and generalized body malaise. Coronavirus disease‑19 (COVID‑19) infection was confirmed by a positive reverse transcription‑polymerase chain reaction. She was diagnosed with severe COVID‑19 pneumonia with progressive oxygen desaturation requiring intubation and intensive care unit admission. The management and bioethical dilemma involved the use of investigational therapeutic interventions for compassionate use, with unknown effects to the fetus, namely remdesivir, tocilizumab, dexamethasone, and hemoperfusion to manage the cytokine storm and prolong pregnancy or to terminate the pregnancy hoping that it might improve the deteriorating condition of the patient. A multidisciplinary approach and family conference to solve the dilemma resulted in a successful outcome.
COVID-19 ; Hemoperfusion

Introduction: As of February 4, 2021, a total of 530,118 COVID-19 cases were recorded in the Philippines with a fatality rate of 2.1%. Significant morbidity from COVID-19 is caused by hyperinflammation. Hemoperfusion (HP), which adsorbs inflammatory cytokines, has been performed in the Philippine General Hospital (PGH) as an adjunct to management given to COVID-19 patients. Objectives: This study aimed to describe the clinical and laboratory profile, ventilatory support, therapeutic regimens, and outcomes of COVID-19 patients who underwent hemoperfusion in PGH. Methods: The COVID-19 patient electronic database (April to September 2020) of the Division of Nephrology was reviewed and we included patients with COVID-19 who underwent hemoperfusion. Demographic, clinical, and laboratory data as well as therapeutics and outcomes were described. Results: Sixty-six patients with COVID-19 underwent hemoperfusion. The majority were male (59.1%) with an average age of 61.3 years (SD 15). Hypertension was the most common comorbidity (62.1%). Acute kidney injury (AKI) requiring dialysis comprised 28.8% while 33.3% had diagnosed chronic kidney disease (CKD). The majority were critical COVID-19 cases who had acute respiratory distress syndrome (ARDS) (56.1%). The mean baseline inflammatory marker levels (Il-6, CRP, LDH, ferritin) were elevated. Post-HP inflammatory markers decreased except for IL-6 among patients who died. Most patients were mechanically ventilated (54.5%). Steroids were the most common medications administered (71.2%). Mortality occurred in 62.1% of the patients. The average length of hospital stay was 20.8 days (SD 19.5), duration from admission to first HP 5.9 days (SD 5.8), and 15.3 days (SD 17.4) from first HP to death or discharge. Conclusion Our study showed the characteristics of patients with COVID-19 who underwent HP. Majority were hypertensive men in their early 60s with critical COVID-19 disease. The mean inflammatory markers were elevated with a decrease in most markers post-hemoperfusion (except for IL-6 among those who died). Despite this, mortality was still high and the average length of hospital stay was long.
Hemoperfusion ; Hemadsorption ; COVID-19

Hemoperfusion ; Humans ; Paraquat ; poisoning ; Poisoning ; therapy

Adult ; Hemoperfusion ; Humans ; Male ; Paraquat ; blood ; poisoning

Hemoperfusion ; Humans ; Liver Failure ; therapy ; Liver, Artificial

Mistakenly picking and eating poisonous mushrooms can cause acute poisoning. In August 2020, Qingdao Hospital of Traditional Chinese Medicine handled a poisonous mushroom poisoning incident, conducted epidemiological investigation on all poisoned patients, collected suspicious food, clinical manifestations, clinical test results and treatment conditions, and identified the mushrooms as Amanita fuliginea poisoning after morphological identification. In this incident, 6 people ate grey goose paste, of which 4 were sick with a incubation period of 6~12 h. The clinical manifestations were gastrointestinal symptoms such as nausea, vomiting and diarrhea, liver and kidney damage. After symptomatic support treatment, hemoperfusion or continuous hemofiltration treatment, the patients were cured and discharged. It is suggested to strengthen the popular science education on poisonous mushroom poisoning and improve the ability of identification and clinical treatment of poisonous mushrooms in grass-roots medical institutions.
Amanita ; Hemoperfusion ; Humans ; Liver ; Mushroom Poisoning/therapy*

OBJECTIVETo evaluate the effect of hemoperfusion on tetramine poisoned patients.

METHODSThree tretramine poisoned cases treated with hemoperfusion were selected. The samples during and after hemoperfusion were collected and analyzed by gas chromatography.

RESULTSTetramine concentration at the inlet of the artificial kidney kept the same level during hemoperfusion. After hemoperfusion, the tetramine concentration in patient plasma changed little in 72 hours. 1.03-1.55 mg of tetramine was adsorbed by the instrument of hemoperfusion after two hours' hemoperfusion.

CONCLUSIONAlthough hemoperfusion was not so effective to reduce blood tetramine concentration in patients, it could clear about 1 mg tetramine for one time.

Child ; Child, Preschool ; Female ; Fluoroacetates ; poisoning ; Hemoperfusion ; Humans ; Infant ; Male

OBJECTIVETo investigate necessity of the further processing for adsorptive resin material.

METHODSAccording to GB/ T 16886.4, coagulation tests, haematology tests, in vitro spontaneous platelet-adhesion test and complement activation tests were conducted respectively to assess the in vitro blood compatibility of adsorptive resin material.

RESULTSIn comparison with polypropylene, he adsorptive resin material appears to be a very slight activator to the endogenous blood coagulation system, it can inhibited the exogenous blood coagulation system very significantly (P < 0.01), it can adhere to fibrinogen, red blood cells, reticulocytes very significantly (P < 0.01), and platelet significantly (P < 0.05). The adsorptive resin material is also revealed to be a very significant activator (P < 0.01) to the complement system.

CONCLUSIONSThe in vitro blood compatibility assessment witnesses that it is very necessary for the adsorptive resin material to go through the certain special processing(such as the surface modification and the microencapsulation technology, etc) before its application to human being.

Hemoperfusion ; Humans ; Metabolic Clearance Rate ; Paraquat ; blood ; pharmacokinetics