1999 Volume 6 Issue 1 Pages 59-63
Hemophagocytic syndrome (HPS) is rare, sometimes fatal disease characterized by hemophagocytosis and multiple organ dysfunction. Underlying pathology includes hypercytokinemia elicited by activated T-lymphocytes and macrophages. Continuous hemodiafiltration (CHDF) has the potential to eliminate cytokines and other cytotoxic factors from the body. This case report was intended to describe whether CHDF has beneficial effects on the treatment of HPS.
A 5-year-old girl weighing 20kg with HPS was treated with CHDF for 70 hours in the ICU. A polymethylmetacrylate hollow fiber filter was connected to an extracorporeal circuit for CHDF. Its blood flow rate was maintained at 30ml·min-1.
Renal functions and clinical manifestations were improved markedly. Tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, IL-6, IL-8, kinetics of myeloperoxidase (MPO) and polymorphonuclear leukocyte elastase (PMNE) were measured. Samples were collected from the CHDF circuit before and after the filter, and ultradiafiltrate at 0, 2, 12 and 24 hours after the start of CHDF. Although serum levels of TNF-αand IL-1β were undetectable, serum levels of IL-6, IL-8, MPO and PMNE were high throughout the period of measurement. The reduction ratio of those variables by CHDF ranged between 14 and 35%. Twenty-four hour eliminations were 2352ng for IL-1β, 126ng for IL-6, 4320ng for IL-8, and 1085 μg for PMNE, respectively.
