What is HA230 in Dialysis/Hemoperfusion for Paraquat Poisoning?
The Jafron HA-230 (and related HA-330) is a hemoperfusion cartridge containing activated charcoal or resin adsorbent material designed to remove toxins, inflammatory mediators, and cytokines from blood through extracorporeal circulation. While this device has been used in sepsis and COVID-19 cases for cytokine removal 1, the provided evidence does not contain specific guidelines or high-quality studies addressing its use specifically in paraquat poisoning.
Understanding Hemoperfusion in Paraquat Poisoning
The Device Technology
- The HA-230/HA-330 cartridges are manufactured by Jafron and can be adapted to standard dialysis machines (such as BBraun Dialog+) 1
- These cartridges use adsorption technology to bind and remove substances from blood as it passes through the device
- They are more cost-effective than continuous renal replacement therapy (CRRT) in resource-limited settings 1
Evidence for Hemoperfusion in Paraquat Poisoning
Hemoperfusion is highly effective at removing paraquat from blood and should be initiated immediately in acute paraquat poisoning. The evidence supporting this includes:
Clearance Efficacy
- Charcoal hemoperfusion removes 93-99% of paraquat from solution in vitro within 160 minutes at 200 mL/min flow rates 2
- In vivo, a single hemoperfusion session can remove 99% of circulating paraquat from blood 2
- Hemoperfusion achieves paraquat clearance of 111±11 mL/min (range 13.2-162.2 mL/min) 3
- This clearance exceeds renal clearance (79.8±56.0 mL/min), especially as kidney function deteriorates—which commonly occurs in paraquat poisoning 3
Clinical Outcomes
- Hemoperfusion combined with continuous veno-venous hemofiltration (CVVH) significantly reduces mortality compared to hemoperfusion alone (43.77% vs 55.26%, OR=0.68) 4
- Combined therapy prolongs survival time in fatal cases and reduces:
Clinical Application Algorithm
When to Initiate:
- Immediately upon presentation with confirmed or suspected paraquat ingestion
- Do not wait for laboratory confirmation—clinical suspicion is sufficient
- Early presentation (ingestion-to-door time ≤4 hours) is associated with better outcomes (71.4% survival vs 20% in late presenters) 5
Monitoring Strategy:
- Use urine sodium dithionite test (UDT) as a bedside guide for hemoperfusion decisions in resource-limited settings 5
- UDT-negative conversion within 10 hours occurs in 77.8% of survivors vs 16.7% of non-survivors 5
- Serial UDT provides a practical, low-cost alternative to plasma paraquat assays 5
Treatment Protocol:
- Initiate hemoperfusion at blood flow rates of 200-300 mL/min for optimal clearance 2
- Combine hemoperfusion with CVVH or hemodialysis for superior outcomes 4
- Continue multiple sessions (survivors receive mean 3.3 sessions vs 2.6 in non-survivors) 5
- Continue until UDT becomes negative and clinical improvement is evident 5
Critical Caveats
⚠️ Despite aggressive extracorporeal treatment, paraquat poisoning carries 50-90% mortality with no specific antidote 5, 6, 7
⚠️ Ingestion of >30 mL of 20% paraquat solution is almost uniformly lethal regardless of treatment 7
⚠️ Early renal function deterioration is common, making hemoperfusion even more critical as the kidneys lose their natural elimination capacity 3
⚠️ Pulmonary fibrosis remains the primary cause of death even with successful initial toxin removal, typically occurring within 28 days 2
Regarding the HA-230 Specifically
While the HA-230/HA-330 cartridges have demonstrated utility in cytokine removal for sepsis 1, no specific evidence in the provided literature directly evaluates these particular Jafron cartridges for paraquat poisoning. The hemoperfusion studies cited used various charcoal cartridges (such as Gambro Adsorba 30C) 2. However, the principle of charcoal-based adsorption for paraquat removal remains consistent across devices.
In practice, any available charcoal hemoperfusion cartridge should be used immediately rather than delaying treatment to obtain a specific brand, as time to treatment initiation is the most critical determinant of survival 5, 7.