Hemoperfusion leads to impairment in hemostasis and coagulation process in patients with acute pesticide intoxication

Abstract

Hemoperfusion (HP) is one of the important treatment modalities in extracorporeal therapy for patients with acute intoxication. Its use has declined during the past 20 years despite its efficacy, because of its side effects, especially an increased risk of bleeding. Mechanisms of hemostasis impairment have not been clearly elucidated and studies demonstrating the mechanism are lacking. It is not clear which step of the hemostatic process is impaired during HP, and whether it leads to an increased risk of bleeding. We performed both in vivo and in vitro studies to elucidate the mechanism of impairment in the hemostatic process. In patients with acute pesticide intoxication who underwent HP, the platelet count decreased rapidly during the first 30 minutes from 242.4 ± 57.7 × 103/μL to 184.8 ± 49.6 × 103/μL, then gradually decreased even lower to 145.4 ± 61.2 × 103/μL over time (p < 0.001). As markers of platelet activation, platelet distribution width increased continuously during HP from 41.98 ± 9.28% to 47.69 ± 11.18% (p < 0.05), however, mean platelet volume did not show significant change. In scanning electron microscopy, activated platelets adhered to modified charcoal were observed, and delayed closure time after HP in PFA-100 test suggested platelet dysfunction occurred during HP. To confirm these conflicting results, changes of glycoprotein expression on the platelet surface were evaluated when platelets were exposed to modified charcoal in vitro. Platelet expression of CD61, fibrinogen receptor, significantly decreased from 95.2 ± 0.9% to 73.9 ± 1.6%, while those expressing CD42b, von Willebrand factor receptor, did not show significant change. However, platelet expression of CD49b, collagen receptor, significantly increased from 24.6 ± 0.7% to 51.9 ± 2.3%. Thrombin-antithrombin complex, a marker for thrombin generation, appeared to decrease, however, it was not statistically significant. Fibrin degradation products and d-dimers, markers for fibrinolysis, increased significantly during HP. Taken together, our data suggests that hemoperfusion leads to impairment of platelet aggregation with incomplete platelet activation, which was associated with reduced thrombin generation, accompanied by increased fibrinolysis.

Evaluation of hematological indices among insecticides factory workers

“…However, neither the exact effect of cholinergic substances on megakaryocyte formation nor the receptors that may mediate these effects have been identified [ 20 ]. Also, in another study, it has been reported that in patients with acute pesticide poisoning, hemoperfusion caused impaired platelet aggregation with incomplete platelet activation, which was associated with decreased thrombin formation with increased fibrinolysis [ 21 ]. Al-Sarar et al.…”

Hemoadsorption Improves Survival of Rats Exposed to an Acutely Lethal Dose of Aflatoxin B1

“…Early hemoperfusion approaches to treat intoxication with modified charcoal have been reported to have undesirable effects on hemostasis and coagulation activity leading to their disuse 45 . In contrast, longer-term clinical studies (30-& 60-day) have established CS treatment to be safe and effective for a number of indications in critically ill patients 46 easing general concerns about disturbances to physiologic homeostasis through untoward removal of beneficial substances, however close drug level monitoring is essential as some antibiotics and other drugs are known to be adsorbed 47 .…”

Comparison of outcomes and costs of extracorporeal blood purification therapies in critically ill COVID‐19 patients

“…Another side effect observed in hemoperfusion is thrombocytopenia. Hemoperfusion has been shown to significantly decrease platelet count and impair coagulation due to direct binding to the absorbent surface or the activation of complement system [ 48 ]. Thrombocytopenia is also observed in plasmapheresis and is most common in centrifugation‐based apheresis and the use of albumin as replacement solution [ 42 ].…”