Hemoperfusion for Large Animals: Background, Basics and the Future in the Treatment of Sepsis

Presentation Description / Summary: Sepsis, defined as an exaggerated systemic inflammatory response to infection, is a common condition in horses and ruminants. Despite substantial advances in medical management, sepsis continues to be a leading cause of illness and death in these patients. While there are reports in the literature on hemodialysis and plasmapheresis in large animals, use of extracorporeal therapy in large animals is exceedingly rare. Extracorporeal therapy works by removing anti-coagulated blood from the patient, filtering the blood through a filter medium and then circulating the blood back to the patient. Though there are a multitude of modifications to how extracorporeal therapy is completed, there are four main categories: hemodialysis, hemofiltration, hemoperfusion (sometimes called hemadsorption therapy), and total plasma exchange. In human medicine there is increasing evidence for the use of hemoperfusion therapy for toxin ingestion, immune-mediated conditions and to decrease cytokine load to help restore proper immune balance in sepsis. Therefore, the purpose of this discussion is to go over the background, the fundamentals, and how we as veterinarians can incorporate hemoperfusion into case management in the future.