Therapeutic Plasma Exchange to Treat Hyperbilirubinemia in Foals

THERAPEUTIC PLASMA EXCHANGE TO TREAT HYPERBILIRUBINEMIA IN FOALS WITH NEONATAL ISOERYTHROLYSIS

Introduction
In high concentrations, and especially in neonates, bilirubin can cross the blood brain barrier. This can lead to irreversible brain damage and nervous symptoms, a syndrome called ‘kernicterus’. When total bilirubin concentrations exceed 350mmol/l, neonates are at high risk to develop kernicterus(1,2). The most important cause of hyperbilirubinemia in foals is neonatal isoerythrolysis(NI). When NI leads to kernicterus, chances for survival are low(1). In human medicine, therapeutic plasma exchange has been successfully used to treat hyperbilirubinemia(3).

Materials and methods
Two foals were presented with NI. Because bilirubin levels continued to rise, plasma exchange treatment was performed using a commercial plasmapheresis device(Baxter Fenwall,Model 200). This device withdraws blood from a patient and separates plasma from red blood cells(RBC) by filtration. Plasma is collected in separate bags and RBC are returned to the patient. At the same time, plasma from a donor horse is administered. […]