HEMOPERFUSION
Introduction
It is an extracorporeal blood purification modality that consists of
the passage of anticoagulated whole blood through a device, usually a
column, that contains adsorbent particles.
Sometimes referred to as hemadsorption, hemoperfusion is used
for the removal of toxins in poisonings and cytokines from septic and
inflamed patients. An increasing range of pathogens and molecules can also
be removed with novel devices.
Difference between Hemoperfusion and Hemodialysis
Hemoperfusion is used for the removal of lipid-soluble substances
from the body while hemodialysis filters out substances that are water-
soluble substances.
How Does it work?
In hemoperfusion, whole blood is passed through a column that
contains fixed adsorbent particles. Engineering of the porous structure of
these particles produces columns with varied adsorption properties. Toxins
with molecular weights ranging from 100 to 40,000 daltons bind to the
particles and are removed as blood exits the column. Binding is through
physical adsorption, governed by molecular size and lipophilicity, through
hydrophobic interactions, van der Waals interactions, hydrogen bonding, or
ionic attraction. Higher-molecular-weight solutes are adsorbed less
efficiently.
 There are two major types of adsorbent particles, including
activated charcoal and resins (such as the hydrocarbon polymer,
polystyrene).
 Charcoal has greater affinity for water-soluble molecules, while
resins have greater affinity for lipid-soluble molecules.
TOXICANTS
Toxicants that are removed by hemoperfusion in overdose such as
theophylline, carbamazepine, methotrexate, phenobarbital, phenytoin,
paraquat (herbicide) and organophosphate (insecticide) poisoning targets
the lungs and affect the tissue in the lungs.
1. Theophylline
2. Carbamazepine
3. Methotrexate
4. Phenobarbital
5. Phenytoin
6. Paraquat Poisoning
7. Organophosphate Poisoning
ADVANTAGES
 It removes the toxic metabolites of methanol and ethylene glycol.
 It corrects electrolyte disturbances and metabolic acidosis, which
is mostly caused by drugs.
 High clearance relative to total body clearance.
 The total surface area of the dialyzing membrane is much greater
than hemodialysis because of the hemoperfusion cartridges.
DISADVANTAGES
 Thrombocytopenia- the platelet count in the blood is too low.
 Leucopenia- decrease in the number of white blood cells.
 Hypocalcemia- there is too little calcium in the blood.
 Hypophosphatemia- the blood has a low level of phosphorous.
 Hypoglycemia- the blood sugar (glucose) level is lower than the
standard range.
 Decrease in fibrinogen
HYPERBARIC OXYGENATION (HBO) THERAPY
Introduction
This involves breathing 100% (pure) oxygen while in a special
space called a hyperbaric chamber. The air pressure inside is raised to a
level that is higher than normal air pressure. 100% pure oxygen while the
one we breath in normal setting consist only of 21% of oxygen.
A type of treatment used to speed up healing of carbon monoxide
poisoning, gangrene, wounds that won't heal, and infections in which tissues
are starved for oxygen.
It's still used to treat sick scuba divers and people with carbon
monoxide poisoning, including firefighters and miners. It has also been
approved for more than a dozen conditions ranging from burns to bone
disease, including:
 Crush injuries
 Decompression sickness
 Acute or traumatic reduced blood flow in the arteries
 Compromised skin grafts and flaps
 Infection in a bone (osteomyelitis) that doesn't respond to other
treatment
 Delayed radiation injury
 Flesh-eating disease (necrotizing soft tissue infection)
 Air or gas bubble trapped in a blood vessel (air or gas embolism)
 Chronic infection called actinomycosis
 Diabetic wounds that are not healing properly
How Does it work?
Only a healthcare provider should prescribe HBOT. A number of
hospitals offer these chambers. People relax, sit, or lie comfortably in these
chambers and take deep breaths. Sessions can last from 45 minutes up to
300 minutes, depending on the reason for the treatment.
Your blood carries the extra oxygen throughout the body, infusing
the injured tissues that need more oxygen so they can start healing. When a
session is done, you may feel lightheaded. Mild side effects include
claustrophobia, fatigue, and headaches.
TOXICANTS
Toxicants that are removed by Hyperbaric oxygenation therapy
are carbon monoxide and cyanide poisoning (sources are gas from
vehicles, factories, burned plastic and cigarette smokes) wherein CO replace
oxygen that is why HBO therapy is use to replace CO.
Gas gangrene poisoning (occurs due to improper hygiene which
causes infection leading to gas gangrene poisoning wherein clostridium
perfringens are the bacteria releasing toxins in the wound). Clostridium
perfringens is a Gram-positive anaerobic spore-forming bacterium that
causes life-threatening gas gangrene
ADVANTAGES
 Helps block the action of harmful bacteria and strengthens the
body’s immunity.
 Can disable the toxins of certain bacteria (most likely Clostridium
perfringens).
 Helps get more blood flow and O2 throughout the body, especially
to the brain.
 Decreases edema because it stimulates better circulation which
will eliminate the fluid built-up.
 Maximizes the effects of antibiotics by optimizing O2 levels in the
body.
 Increases angiogenesis (development of new blood vessels).
 Stimulates growth factors in the blood platelets.

DISADVANTAGES
 Fatigue and lightheadedness
 Barotrauma of the ear- Barotrauma is an injury due to increased
pressure. During compression, if the air pressure in the middle-ear
cannot be equalized with the external pressure, the eardrum will
bow inward, leading to pain and possibly rupture, leading to
hearing loss.
 Sinus damage- Failure to equalize the pressure in the sinuses
and the external environment leads to severe pain and possibly
bleeding into the sinuses.
 Changes in vision, causing nearsightedness, or myopia-
Hyperbaric oxygen therapy treatments can temporarily change the
shape of the lens in the eye. This usually results in worsening
myopia (nearsightedness). This change usually reverts back to its
pre-treatment status six-eight weeks after treatments stop.
 Oxygen poisoning, which can cause lung failure, fluid in the
lungs, or seizures- The high level of oxygen in the blood that
occurs during HBO treatments can be toxic to the central nervous
system and can result in seizure activity.