The Influence of Hypoalbuminemia on Maximal Flow Rates and Transmembrane Pressure during Plasmapheresis – An in vitro Study

Background: Plasmapheresis has been used for the treatment of acute liver failure (ALF). In these patients, hypoalbuminemia is often observed. Since albumin improves the disaggregability of erythrocytes, hypoalbuminemia might deteriorate rheology and thus influence the overall performance of plasmapheresis. Methods: Hypoalbuminemia was mimicked by using porcine blood because of its physiologically low albumin/globulin ratio (AGR). Filters (n = 16) were integrated in a closed extracorporeal in vitro system. In the control group (n = 8), native porcine blood (AGR 0.8) was used. In the study group (n = 8), we used porcine blood supplemented with human albumin to obtain the human AGR value of 1.2. Two different heparinization protocols were compared in each group (2.5 IU/ml: n = 4 with albumin and n = 4 without albumin versus 5 IU/ml: n = 4 with and n = 4 without albumin). Results: In both heparinization protocols the higher AGR led to lower transmembrane pressure (TMP) levels compared to the lower AGR. The reduced TMPs enabled higher blood flow and filtration rates. Conclusion: Maintenance of a physiological AGR in ALF patients might improve the performance of plasmapheresis and – as opposed to raised heparinization – contribute to a safer application.

[1]  J. Stange,et al.  Dialysis against a recycled albumin solution enables the removal of albumin-bound toxins. , 2008, Artificial organs.

[2]  T. Risler,et al.  Improvement of hepatorenal syndrome with extracorporeal albumin dialysis mars: Results of a prospective, randomized, controlled clinical trial , 2000, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[3]  T. Schiano,et al.  Correlation Between Increased Colloid Osmotic Pressure and the Resolution of Refractory Ascites After Transjugular Intrahepatic Portosystemic Shunt , 2000, Southern medical journal.

[4]  I. Ebihara,et al.  Effect of Plasma Exchange on Serum Tissue Inhibitor of Metalloproteinase 1 and Cytokine Concentrations in Patients with Fulminant Hepatitis , 2000, Blood Purification.

[5]  L. Jiang,et al.  [Clinical manifestation and pathological change of autoimmune hepatitis]. , 2000, Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology.

[6]  R. Rossaint,et al.  Extrakorporale Leberunterstützungsverfahren in der Therapie des akuten Leberversagens Eine Standortbestimmung , 1999, Der Anaesthesist.

[7]  P. Mertens,et al.  Long-Term Extracorporeal Bilirubin Elimination: A Case Report on Cascade Resin Plasmaperfusion , 1998, Blood Purification.

[8]  I. Mekjavic,et al.  Hyperbaric oxygenation, plasma exchange, and hemodialysis for treatment of acute liver failure in a 3-year-old child. , 1998, Artificial organs.

[9]  A. Demetriou,et al.  Artificial liver: review and Cedars-Sinai experience. , 1998, Journal of hepato-biliary-pancreatic surgery.

[10]  S. Nyberg,et al.  Hepatocyte liver-assist systems--a clinical update. , 1998, Mayo Clinic proceedings.

[11]  E. Rackow,et al.  EFFECT OF CRYSTALLOID AND COLLOID SOLUTIONS ON BLOOD RHEOLOGY IN SEPSIS , 1997, Shock.

[12]  J. F. Wang,et al.  Viscosity measurements for LEH suspended in different plasma expanders. , 1997, Artificial cells, blood substitutes, and immobilization biotechnology.

[13]  N. Starr,et al.  Clinical characteristics of preoperative hypoalbuminemia predict outcome of cardiovascular surgery. , 1997, JPEN. Journal of parenteral and enteral nutrition.

[14]  A. Sueoka.  Present status of apheresis technologies: Part 1. Membrane plasma separator. , 1997, Therapeutic apheresis : official journal of the International Society for Apheresis and the Japanese Society for Apheresis.

[15]  D. Shukla,et al.  Prognostic markers in amebic liver abscess: a prospective study. , 1996, The American journal of gastroenterology.

[16]  G Cloutier,et al.  Comparison and simulation of different levels of erythrocyte aggregation with pig, horse, sheep, calf, and normal human blood. , 1996, Biorheology.

[17]  K. Therkelsen,et al.  Endothelin-1 in patients with fulminant hepatic failure: influence of high-volume plasmapheresis. , 1995, Transplantation proceedings.

[18]  M. Kaibara.  Rheology of blood coagulation. , 1995, Biorheology.

[19]  Y. Yajima,et al.  Continuous removal of middle molecules by hemofiltration in patients with acute liver failure , 1990, Critical care medicine.

[20]  C. Record,et al.  Plasmapheresis in Acute Liver Failure , 1986, The International journal of artificial organs.

[21]  N. Maeda,et al.  Opposite effect of albumin on the erythrocyte aggregation induced by immunoglobulin G and fibrinogen. , 1986, Biochimica et biophysica acta.

[22]  C. Zarins,et al.  Balanced electrolyte solutions: experimental and clinical studies , 1979, Critical care medicine.

[23]  R. Ruess,et al.  Comparison of hemodynamic, pulmonary, and renal effects of use of three types of fluids after major surgical procedures on the abdominal aorta , 1979, Critical care medicine.

[24]  D. Weaver,et al.  Effects of albumin versus non-albumin resuscitation on plasma volume and renal excretory function. , 1978, The Journal of trauma.

[25]  E. H. Courtiss,et al.  Randomized trial of albumin vs. electrolyte solutions during abdominal aortic operations , 1976 .

[26]  E. Salzman,et al.  Randomized trial of albumin vs. electrolyte solutions during abdominal aortic operations. , 1975, Surgery.

[27]  S Chien,et al.  Shear-dependent interaction of plasma proteins with erythrocytes in blood rheology. , 1970, The American journal of physiology.

[28]  P. Dodek,et al.  Distribution of normal saline and 5% albumin infusions in septic patients. , 1999, Critical care medicine.

[29]  D. Falkenhagen,et al.  Fractionated plasma separation and adsorption system: a novel system for blood purification to remove albumin bound substances. , 1999, Artificial organs.

[30]  R. Williams,et al.  Bioartificial liver support: developments in hepatocyte culture and bioreactor design. , 1997, British medical bulletin.

[31]  E. Boulanger,et al.  Erythrocyte sedimentation rate, an underestimated tool in chronic renal failure. , 1996, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[32]  R. Hughes,et al.  Use of sorbent columns and haemofiltration in fulminant hepatic failure. , 1993, Blood purification.

[33]  A. Pries,et al.  Time-dependent rheological behaviour of blood flow at low shear in narrow horizontal tubes. , 1989, Biorheology.

[34]  H. Schmid-schönbein.  Fahraeus-effect-reversal (FER) in compaction stasis (CS): microrheological and haemodynamic consequences of intravascular sedimentation of red cell aggregates. , 1988, Biorheology.

[35]  C. Bucherer,et al.  Competitive role between fibrinogen and albumin on thixotropy of red cell suspensions. , 1988, Biorheology.

[36]  H. Rogausch.  The apparent viscosity of aggregating and non-aggregating erythrocyte suspensions in the isolated perfused liver. , 1987, Biorheology.

[37]  T. Dobashi,et al.  Erythrocyte sedimentation rate. I. Volume fraction dependence in saline solution. , 1987, Biorheology.

[38]  K. Kon,et al.  Study of the effect of varying hematocrit on free deformation and orientation of erythrocytes in flow. , 1985, Biorheology.