A comparison of hemoperfusion columns for paraquat

The efficiency of charcoal hemoperfusion (HP) columns during the treatment of paraquat poisoning by continuous hemoperfusion is poorly documented, and fears of saturation of the charcoal by paraquat have led to replacement of the column in as little as 2-4 hr. Four commercially availably HP devices were compared in a prospective study of 54 patients who had ingested paraquat deliberately. The charcoal columns studied were Hemosorba CH-350 (Asahi Medical, Tokyo, Japan), DHP-1 (Kuraray, Osaka, Japan), Adsorba 300 (Gambro Dialysatoren KG, Hechingen, West Germany) and Hemokart-Adult (National Medical Care, Rockleigh, NJ, USA). Plasma paraquat levels were measured at the inlet and outlet 15 min after the commencement of HP, and hourly during the next 12 hr or until HP was ceased (if less than 12 hr). Platelet levels were measured before HP and every 4 hr thereafter. All 4 types showed almost 100% removal at 15 min and maintained this efficiency throughout the period studied. Both DHP-1 and Hemokart-Adult caused minimal thrombocytopenia (mean always greater than 100,000/mm3). Adsorba 300 and Hemosorba CH-350 caused marked thrombocytopenia, and the levels with Adsorba 300 were significantly lower than for DHP-1 and Hemokart-Adult (P less than 0.05). The thrombocytopenia induced by Adsorba 300 often required platelet transfusions or cessation of HP. Commercially available HP columns are not saturated by the paraquat levels met clinically, so longer use of each column should be considered.