hemoperfusion

Hemoperfusion is an extracorporeal therapy in which blood is passed through an adsorbent cartridge to remove toxic substances or inflammatory mediators from the circulation. The cartridge contains adsorbent materials such as activated charcoal, resin, or polymer beads that bind target substances as blood flows through. This mechanism allows removal of substances that are not readily cleared by conventional dialysis.

Indications include life-threatening poisonings or metabolic disturbances where other treatments are insufficient, especially toxins with high protein binding or large volume of distribution. Classic targets include theophylline, phenobarbital, valproic acid, carbamazepine, salicylates, and certain pesticides or paraquat. Hemoperfusion is sometimes used in septic shock or endotoxemia in conjunction with other therapies, and may be combined with hemodialysis.

Devices vary by target. Early systems used activated charcoal or resin cartridges; newer platforms include polymyxin B-immobilized cartridges for endotoxin removal in gram-negative sepsis and cytokine adsorber cartridges to reduce inflammatory mediators. Evidence is heterogeneous; some case series and small trials suggest benefit in select poisonings, but randomized trials are limited and guidelines stress selective, case-by-case use.

Complications include hypotension and other circuit-related events, bleeding risk from anticoagulation, thrombocytopenia, and catheter- or membrane-related problems. Hemoperfusion requires specialized equipment and trained personnel; it is not a universal substitute for dialysis or other detoxification methods, and dosing and monitoring must be adjusted for concomitant therapies and organ function.