Potential Risks and Side Effects of Hemoperfusion Therapy

Hemoperfusion is an advanced extracorporeal blood purification technique increasingly used in clinical settings—especially for treating drug overdoses, poisoning cases, and certain metabolic disorders. While highly effective at removing toxins through adsorption, this therapy carries several clinically significant risks that both healthcare providers and patients should understand thoroughly.

Common Complications Associated with Hemoperfusion

1. Increased Risk of Coagulation and Clotting Events

One of the most frequently observed complications is extracorporeal circuit clotting. Unlike standard hemodialysis, hemoperfusion involves a dedicated adsorption column—typically packed with high-surface-area materials such as activated charcoal or synthetic resin beads. These porous media dramatically increase the contact surface between blood and foreign surfaces, triggering platelet activation and the intrinsic coagulation cascade. As a result, anticoagulation management becomes critical: most protocols require careful titration of heparin or low-molecular-weight heparin (LMWH), and some centers opt for regional citrate anticoagulation—especially in patients with high bleeding risk or heparin-induced thrombocytopenia (HIT).

2. Hypersensitivity and Allergic Reactions

Patients may develop acute allergic or pseudoallergic responses during or shortly after treatment. These reactions range from mild symptoms—including flushing, rash, and chest tightness—to life-threatening anaphylactoid episodes characterized by bronchospasm, hypotension, and respiratory distress. The root cause often lies in the interaction between plasma proteins and the adsorbent material's surface chemistry, leading to complement activation (particularly the C3a and C5a pathways) rather than true IgE-mediated allergy. Pre-treatment assessment of atopy history and prophylactic use of antihistamines or corticosteroids are recommended for high-risk individuals.

3. Acute Hypotension and Hemodynamic Instability

Transient hypotension occurs in up to 15–20% of hemoperfusion sessions—primarily due to the device's priming volume (typically 150–200 mL) and the sudden sequestration of vasoactive substances (e.g., catecholamines, bradykinin, and inflammatory mediators) by the adsorbent. This effect is compounded by fluid shifts, reduced systemic vascular resistance, and potential cytokine modulation. Clinicians must monitor blood pressure continuously, ensure adequate intravascular volume status pre-treatment, and consider slower blood flow rates (150–200 mL/min) for frail or elderly patients. In some cases, vasopressor support or albumin infusion may be required to maintain hemodynamic stability.

Mitigation Strategies and Best Practices

To minimize adverse events, evidence-based guidelines emphasize individualized risk assessment, real-time monitoring, and protocol-driven interventions. Key recommendations include: performing baseline coagulation panels (PT/INR, aPTT, platelet count), screening for known allergies or prior adverse reactions to adsorbents, optimizing hydration status before initiation, and using modern biocompatible adsorption cartridges with reduced complement activation profiles. Ongoing staff training and standardized checklists further enhance procedural safety and improve patient outcomes.

When to Seek Immediate Medical Attention

Patients undergoing hemoperfusion—or their caregivers—should be educated to recognize red-flag symptoms, including sudden shortness of breath, severe dizziness or fainting, widespread hives or swelling (especially of the lips or throat), unexplained chills or fever, or persistent chest discomfort. Prompt reporting and rapid clinical evaluation can prevent progression to serious complications such as shock, acute kidney injury, or disseminated intravascular coagulation (DIC).