Extended Double Plasma Molecular Adsorption Sessions and Bilirubin Clearance: A Case Report

BACKGROUND: The double plasma molecular adsorption system is an artificial-liver treatment model combining the use of ion exchange resins and neutral microporous resins to remove toxins such as inflammatory cytokines without consuming large amounts of plasma and albumin. Given the relatively expensive consumables needed for Bilirubin adsorption, extending treatment duration and maximizing adsorption column efficiency help save medical expenses and resources. CASE PRESENTATION: We report on a 51-year-old male hyperbilirubinemia patient of Chinese Han ethnicity, which was treated with prolonged double plasma molecular adsorption system sessions. The patient underwent two treatment sessions, each lasting over 6 h with a plasma adsorption volume greater than 10 L. total bilirubin clearance was 44.6% in the first session and 34.6% in the second. Dynamic monitoring of serum total bilirubin showed that clearance was maximized when plasma adsorption volume equaled the patient's plasma volume. When plasma adsorption volume reached 2 × plasma volume, total bilirubin decreased by less than 20%, indicating near-saturation of the column's bilirubin adsorption capacity. After plasma adsorption volume doubled in the first session, total bilirubin clearance dropped to nearly 20%, suggesting that the column still had some adsorption capacity. While the efficiency of bilirubin removal per unit of plasma volume decreased, continuing the treatment still allowed for the elimination of additional bilirubin. CONCLUSION: Total plasma adsorption volume in a single double plasma molecular adsorption system treatment session can serve as a reference for determining the therapeutic dose in future treatments. Furthermore, extending the treatment duration with a bilirubin adsorption column enhances bilirubin clearance.