2011 Volume 2 Issue 1 Pages 122-126
A 79 year-old man was admitted to our hospital and diagnosed with a low rectal adenocarcinoma. He was underwent a low anterior resection but subsequently developed pan-peritonitis due to an anastomotic leak. He was operated again but developed sepsis and acute kidney injury. Blood purification therapy was chosen against acute kidney injury, sepsis and extreme hypercytokinemia. Continuous hemodiafiltration (CHDF) using polymethyl methacrylate (PMMA) hemofilter was carried out, but he fell shock immediately and responded transiently to rapid transfusion and catecholamines. On the next day, started PMMA-CHDF, he fell shock again with decline in systemic vascular resistance. Blood pressure doesn’t respond to escalating dose of catecholamine but recover from shock by retransfuion. Laboratory data showed that number of monocytes was upregulated, but number of eosinophils nor IgE was not increased. After changed the hemofilter to Polysulfone menbrane, CHDF was performed without any problem. PMMA hemofilter is thought to have high biocompatibilities and to be safe. In the present case, hyper-reaction against PMMA hemofilter was thought to be the cause of refractory shock. Monocyte might play key role of hyper-reaction against PMMA hemofilter.
