Extracorporeal processing of blood is known to have many uses. Such processing may be used, for example, to provide treatment of a disease. Hemodialysis is the most commonly employed form of extracorporeal processing for this purpose. Additional uses for extracorporeal processing include extracting blood components useful in either treating others or in research. Apheresis of plasma (i.e., plasmapheresis) and thrombocytes, or platelets, are the procedures most commonly employed for this purpose. Also, non-therapeutic devices have been developed to analyze blood which may involve extraction of blood components. For example, some devices can separate blood and plasma, or specific analytes, for purposes of diagnosis.
Devices for separating and filtering components of all types of fluids are known. For example, filtration may be used to separate components for analysis or for production of food products. Microfluidic devices for separating and cleansing fluid components have been proposed. These types of devices pose technical challenges that are addressed by the presently disclosed subject matter.
Objects and advantages of embodiments of the disclosed subject matter will become apparent from the following description when considered in conjunction with the accompanying drawings.
Embodiments will hereinafter be described in detail below with reference to the accompanying drawings, wherein like reference numerals represent like elements. The accompanying drawings have not necessarily been drawn to scale. Where applicable, some features may not be illustrated to assist in the description of underlying features.
Effective microfluidic cross-flow filtration may be limited by streamwise pressure loss in the retentate channel. In microfluidic channels, in the presence of high shear rates, the pressure difference across the cross-flow filter can be much higher at the upstream end of the cross-flow filter than at the downstream end. If the upstream pressure is adjusted to make it low, there may result a backflow of filtrate at the downstream end of the filter. In cross-flow filtration of fluids that have very high particle fraction, such as whole blood, high upstream pressure may lead to compaction of filtered material on the filter surface. For example, particle fraction of blood is the volume fraction of cytoplasmic bodies in the whole blood. The compaction results in blockage of the open area of the filter. In many configurations and operational regimes, including multi-phase fluid properties, there may not be a window of operability between these extremes.
In a high particle volume fraction fluid, it has been determined by experiment, that exceeding a certain critical TMP at the upstream end of a microfluidic retentate channel can cause an entire filter to clog up due to a runaway instability effect in which as the excess TMP clogs the upstream end, the high TMP region moves downstream, clogging the remaining part of the filter and so on until no filtration occurs at all. It has been discovered that this effect can be mitigated by flowing the permeate in a concurrent flow relationship with the flow in the retentate channel as now discussed with reference to
Referring now to
In embodiments, the crossflow filtration configuration of
In further embodiments, the volume fraction of particles in the retentate flow is more than 10% and in further embodiments it is the fraction in whole blood. In variations of the above, blood is prediluted to reduce the volume fraction, using blood normal solution or plasma. In embodiments, the flux rate across the filter is between 5 and 20 percent of the flow rate of the retentate flow. In embodiments, blood from a living patient flows continuously in the channel 114 for days without substantial destruction of cells in the blood. In further embodiments, the plasma is ultrafiltered to 5 to 20 percent of the volume by removal of water and solutes and the reduced product returned to the living patient or, alternatively, the plasma is recirculated at a volume rate that is higher or lower than the rate of blood flow in order to generate the permeate flow pressure profile shown in
By providing a flow through the permeate channel, it is possible to mitigate the above-described undesirable effects by reducing the variation in the transmembrane pressure along the streamwise axis of the cross-flow filter. Pressure drop along the retentate channel suspension channel is offset by a pressure drop along the permeate channel in which a concurrent flow is established.
Referring to
Referring now to
A problem that may arise in the configuration of
In the case of an ultrafilter being used as the processor 560, the flow of plasma, including macromolecules, across the filter 507 is balanced by a stream of filtrate 572, but the macromolecules are retained by the ultrafilter. This causes the macromolecules to concentrate in the recirculating plasma (permeate) flow. To balance what would otherwise be continuously concentrating material retentate in channel 558, for long term treatment embodiments, a fraction of the concentrated plasma flows through a branch 556 back to the return blood stream 573 via a junction 550. In an alternative embodiment, the return plasma flows back to the arterial line 512 for immediate flow through the separation module 505. A flow restrictor 554 may be provided along with a check valve 552. A further flow restrictor 572 may also be provided to create a flow resistance in the retentate stream exiting the filtration device 505. By appropriately controlling the pumps 508 and 510 and assuming appropriate selection of the flow restrictors 554 and 572, a net flow of macromolecules in a concentrated flow can be returned to the blood of the patient while still permitting a net flow of water and crystolloid solutes to be extracted by the processor 560 for an indefinite period.
Referring now to
To return the concentrated HMW component stream, the pump 616 creates a positive TMP across filter 607 thereby flowing plasma, concentrated in macromolecules, from a filtrand channel 618 to a filtrate channel 612 and on to a venous line 610 for return to the venous line 610 and on to the patient 602. Flow restrictors may be provided as required to achieve the required driving pressures. The separation module 619 may function in the same manner as separation module 614 in having a cross-flow configuration with a limited range of TMP. In an alternative embodiment, the separation module 619 is replaced by a simple chamber with a microsieve filter on the lower side 618 where the sweeping effect used to clear cytoplasmic bodies from the filter 605 of separation module 617 is not needed. The filtrate side 612 however may benefit from such sweeping effect but it may not be necessary, depending on the particular conditions. Thus, filtrand and filtrate sides 618, 612 may be flow plenums without substantial pressure drop, in embodiments. In alternative arrangements, the return flow of concentrated plasma is pumped directly to a second venous line to the patient while blood returns through a first venous line, rather than forming a mixed stream. This embodiment is illustrated in
As in the embodiments of
Referring now to
As in the prior embodiment, in an alternative embodiment, the separation module 618 is replaced by a simple chamber with a microsieve filter on the lower side 618 where the sweeping effect used to clear cytoplasmic bodies from the filter 605 of separation module 617 is not needed. The filtrate side 612 however may benefit from such sweeping effect but it may not be necessary, depending on the particular conditions. Thus, filtrand and filtrate sides may be simple flow chambers, in embodiments.
Referring to
In the embodiments of
An alternative to recirculating the permeate to provide a large concurrent flow to produce a pressure drop in the permeate channel is to shape the permeate channel such that sufficient streamwise pressure drop in the permeate channel occurs due to the permeate flow alone. An alternative to recirculating the permeate to provide a large concurrent flow to produce a pressure drop in the permeate channel is to shape the permeate channel such that sufficient streamwise pressure drop in the permeate channel occurs due to the permeate flow alone. For example, in a permeate channel tapered from a narrow height at the inlet end to a taller height at the outlet end, an initially small permeate flow in the streamwise direction is attended by a concomitantly high resistance and resulting streamwise pressure drop. If the retentate flow is being maintained at a constant level, also the pressure drop along the retentate channel has a constant value. This same pressure drop along the permeate channel can be maintained (herewith enabling a constant TMP along the filter) provided that the permeation rate is constant and the tapering of the permeate channel is properly adapted to enable this.
In embodiments, the passive concurrent flow configuration may be achieved within the body of a micro-sieve chip. The flow resistance scales cubic with the permeate channel height, thus tapering the channel height is preferred. For example the bottom of the permeate channel can be designed to have sufficient tapering to enable passive concurrent flow. Since there is a loss of flow from the retentate channel, the retentate channel may also be tapered so that its cross-section diminishes in a streamwise direction. Some other variations are illustrated in
For plasma filtration embodiments of the concurrent flow embodiments a flow rate in the retentate channel (e.g., 606 in
In an initial startup of a system, a substitute fluid may be used in the recirculating permeate channel until the volume of permeate builds up and displaces it. For example, in a blood treatment system, a blood-normal fluid such as sterile dialysate may be used to prime the blood and plasma channels before the introduction of blood. The flow of permeate may displace the priming fluid as well. Alternatively, or in addition, plasma from an outside source may be used to prime the recirculating permeate channel.
The elements of the disclosed fluid circuits may be combined to form modules of a simplified system. That is, although depicted as interconnected filtration devices, it is possible to combine the filtration devices 617 and 619 of
According to embodiments, the device of
In a preferred configuration, the maximum filtration rate is empirically established for the particular embodiment (a method of establishing the maximum filtration rate is described below) including the particular wall filters, blood channel height, and other parameters for a single channel device in order to omit the influence of instabilities or other dependencies on the plumbing of the blood plasma separation device as a whole. The maximum filtration rate may be determined according to a selected shear rate which is established based on blood properties and other medical factors, for example, such as safety and tolerance for hemolysis. For example, anemic patients may have a low tolerance for hemolysis by the blood treatment. In an example, a shear rate of 7500 sec-1 may be used and the single layer blood plasma separation device operated to determine the maximum filtration rate, for example using the procedure of
Although the embodiment of
Note that in the embodiment of
In the disclosed embodiments, the processor may be replaced by an adsorption device, a further filter, an ultrafilter (e.g., dialyzer), diafilter, or other processing device. In any of the embodiments, the pumps may be peristaltic pumps. In any of the embodiments, flow dampeners may be used to mitigate pressure pulses due to the pumps.
It has been observed that in filtering whole blood, a layer of cytoplasmic bodies, principally erythrocytes, accumulates on the cross-flow filter. This may result in a passivation of the surface of the filter. It does add to the flow resistance of the filter and observations demonstrate that the porosity of the filter is not a significant design parameter within the range of porosities tested.
In example embodiments, the performance of the filtration device has been confirmed with whole blood. A cross-flow filter having 1.56 cm2 active area, with pores of a slot configuration, 0.6 μ wide by 2 μ long was employed in tests. Blood and plasma were pumped in parallel flows on opposite sides of the cross-flow filter to effect a continuous cross-flow achieving up to 1.5 ml/min. The following table shows examples of tests over periods of 1.5 hrs. comparing maximum flow of plasma across the cross-flow filter using concurrently flowing permeate (plasma) and flow without the concurrent flow.
In any of the foregoing embodiments, the crossflow filter may be fabricated from any suitable material. For example, organic and inorganic materials and composites including polymers, materials, ceramic, metals, etc. Examples of materials are listed in U.S. Pat. No. 5,753,014.
Note that in any of the embodiments, patient accesses may take the form of any type of access including a fistula, central line, and employ one or more needles, cannulae, or catheters, mulitiple-lumen cannulae or catheters or other devices. The illustration showing an arm should be understood as symbolic of any type of blood access device.
According to embodiments, the disclosed subject matter includes a filtration apparatus with a crossflow filter that has a retentate channel with inlet and outlet ends and a permeate channel adjacent to the retentate channel with inlet and outlet ends. The permeate and retentate channels are separated by a crossflow filter. A recirculation channel connects the permeate channel outlet end with the permeate channel inlet end. The recirculation channel is connected to the permeate channel outlet end through a treatment component that alters a property of the flow in the recirculation channel. A property control device extracts a fraction of the flow in the recirculation channel at a flow rate that maintains constant property of the flow in the recirculation channel. At least one pump may be used in the recirculation channel for flowing fluid therethrough.
The property control device may include a check valve or it may include in addition or alternatively, a filter that separates the recirculation channel from a flow emanating from the retentate channel outlet. The property control device may also include a cross-flow filter having similar construction to that of the crossflow filter used for primary separation. In embodiments, the property control device may be configured to sustain a constant level of a property in the recirculation channel by continuously removing a fraction of the fluid therein, which is replaced by fresh permeate, thereby creating a balance. For example, if the property modified by the treatment component is an ultrafilter filtrate fractions remaining in the recirculation channel may concentrate to a higher level than in the permeate flowing into the recirculation channel. By drawing off a fraction of the flow in the recirculation channel, the continuous replenishment with permeate from the crossflow filter allows a balanced composition to be maintained, e.g., in this case, a predefined level of concentration of the ultrafilter's filtrate. In further variations of the above embodiment, a pump may be connected to the retentate channel inlet. A blood access line may be connected to the retentate channel inlet. The permeate channel may have a tapered cross-section. The retentate and permeate channels may have tapered cross-sections such that the retentate channel diminishes in cross-sectional area and the permeate channel increases in cross-sectional area. The cross-flow filter, pumps and channels may be sized such that a stable flow of blood plasma through the cross-flow filter may be achieved with a flow of blood in the retentate channel. The permeate channel of the crossflow filter may have a series of spaced structural members that restrict flow at a point coinciding therewith and which receive permeate from the retentate channel between them. The structural members may be configured to stiffen the filter. The filter may have a smooth flat polished surface that helps to keep retentate particles from adhering to the filter surface. The filter may have regularly spaced straight pores with an aspect ratio (axial length of pore to diameter) of no more than ten. The aspect ratio may be less than 5 or may be no more than two. The pores may be straight, non-branching channels. The property control device may include a fluid connector configured to direct a fraction of a flow in the recirculation channel directly to a patient. The recirculating flow can be returned to the patient by a variety of means for example a dual lumen catheter in a patient central line may be used to flow retentate and a fraction of the recirculating permeate directly to the patient's access. Alternatively, the two flows can be combined and flowed through a single lumen catheter into the patient. For example, the two flows may converge in a junction which is attached at the base of the junction to the single lumen. A triple lumen catheter may be used to draw the primary flow from the patient and return the recirculating permeate and crossflow filtered retentate back to respective lumens of the triple lumen catheter or cannula.
According to embodiments, the disclosed subject matter includes a method for cross-flow filtering plasma from whole blood while maintaining a positive transmembrane pressure of a streamwise length of a filter used for the cross-flow filtering. The method includes removing ultrafiltrate from the plasma resulting from the cross-flow filtering and returning a result of the removing to a source of the whole blood. The filter may have non-branching channels. The filter may have straight channels therethrough with uniform pore size between 0.02 micron and 2 microns. The maintenance of positive pressure may include co-flowing plasma on a permeate side of the filter such that a pressure drop in a streamwise direction is maintained. The streamwise flow on the permeate side of the filter produces a pressure drop along the filter that compensates for a pressure drop along the retentate side. The method may include returning ultrafiltrate to a permeate side of the filter to generate a flow generating a streamwise pressure drop therealong. The plasma flow through the cross-flow filter may be in the range of 0.1 to 10 ml/min. The flow rate of plasma through the cross-flow filter may be between 5 and 25 percent of the rate of flow of whole blood into the filtration device. The cross-flow filtering may include flowing blood in a microfluidic channel having a depth less than 500 microns. In embodiments, the channel may have a depth less than 300 microns. The cross-flow filtering may include compacting a layer of blood cells on the surface of a cross-flow filter. The maintenance of positive pressure may aided by co-flowing plasma on a permeate side of the filter such that a pressure drop in a streamwise direction maintained. The method may further include concentrating blood proteins in the co-flowing plasma and returning a result thereof to the source of blood such that the net flow of cross-flow filtered plasma is equal to the net flow of ultrafiltrate and a net flow of the returning. The returning may include flowing the plasma resulting from the concentrating through a filter back to a patient blood stream. The maintaining may be effective to provide a constant transmembrane pressure over an entirety of a cross-flow filter. The cross-flow filtering may include flowing whole blood through a channel having a depth of less than 500 microns. The cross-flow filtering may include flowing whole blood through a channel having a depth of 200 microns or less. The cross-flow filtering may include flowing whole blood through a retentate channel having a depth of less than 500 microns, wherein the maintaining includes flowing recirculated plasma through a channel whose depth is less than the retentate channel depth. The cross-flow filtering may include flowing whole blood through a retentate channel having a depth of less than 500 microns, wherein the maintaining includes flowing recirculated plasma through a channel whose depth is about half the retentate channel depth. A flow of plasma across a filter in the cross-flow filtering may be greater than 0.5 cm3/cm2 of cross-flow filter area.
According to embodiments, the disclosed subject matter includes a method of cross-flow filtering a suspension having a particle volume fraction of at least 1 percent. The method includes cross-flow filtering the suspension by flowing permeate from a retentate side of a filter to a permeate side while flowing the suspension along the retentate side. The method further includes generating a pressure drop along the permeate side of the filter by recirculating a portion of the permeate across the filer permeate side. In this embodiment, the generating is effective to create a positive transmembrane pressure over an entirety of the cross-flow filter used to filter the suspension. The method may include extracting a product stream from a flow on the permeate side.
According to embodiments, the disclosed subject matter includes a microfluidic separation device with a fluid circuit device having multiple flow channels fed from a common fluid header. Each flow channel has parallel facing opposing walls separated by a separation distance of 500 microns or less. Each flow channel has an inlet and a plurality of outlet openings along the walls spanning a streamwise span of the walls. A fluid delivery system is connected to the flow channel and configured to deliver a predefined fluid to the flow channel. The predefined fluid is a fluid with suspended particles which exhibits the property of there being a predefined maximum filtration rate through the plurality of outlet openings for a given shear rate across the plurality of openings. A controller is configured to regulate flow rates of the fluid delivery system to control a filtrand flow rate through the at least one flow channel and to control a filtrate flow rate through the outlet openings at at least 10% below the predefined maximum filtration rate. The predefined fluid may be blood and the fluid delivery system may include a patient vascular access. A processor may be configured for receiving the filtrate from the fluid circuit device. An ultrafilter may be configured to receive the filtrate from the fluid circuit device and return concentrated filtrate to the patient. The flow channel may be a rectangular flow channel, and the walls may be facing opposing walls whose widths are at least ten times the separation distance between them.
According to embodiments, the disclosed subject matter includes a microfluidic separation method that includes providing a fluid circuit device with multiple flow channels, each having parallel facing opposing walls separated by a separation distance of 500 microns or less, wherein each flow channel has an inlet and a plurality of outlet openings along the walls spanning a streamwise span of the walls. The method includes delivering a fluid suspension to the flow channel, wherein the fluid suspension is one that exhibits a property of there being a predefined maximum filtration rate through the plurality of outlet openings for a given shear rate across the filter. The method includes regulating a flow rate of the fluid suspension through the flow channel at a rate corresponding to a predefined shear rate and regulating a filtrand flow rate through the plurality of openings at at least 10% below the predefined maximum filtration rate. The predefined fluid may be blood and the fluid delivery system may include a patient vascular access.
The method may further include flowing filtrate through a processor configured for receiving the filtrate from the fluid circuit device. The method may include ultrafiltering filtrate from the plurality of openings and returning concentrated filtrate to the patient. The predefined shear rate may be at least 2000 sec-1. The predefined shear rate may be at least 3000 sec-1, 5000 sec-1, or at least 7000 sec-1 in respective embodiments.
According to embodiments, the disclosed subject matter includes a system for ultrafiltering blood having a crossflow filtration apparatus with a crossflow filter configured to separate plasma from blood received through an arterial blood line. The crossflow filtration apparatus is configured to recirculate plasma in a recirculation channel connecting a plasma permeate outlet of the crossflow filtration apparatus to a plasma permeate recirculating flow connected to an inlet of the cross flow filtration apparatus. A plasma pump in the recirculation channel is configured to maintain a flow therein such as to maintain a substantially constant transmembrane pressure at all points of a surface of the crossflow filter. The channel has an ultrafilter arranged to remove water from a flow from plasma in the channel and a return filter separating the recirculating channel from a venous blood line connected to a retentate outlet of the crossflow filtration apparatus. A blood pump along with the plasma pump are arranged to flow plasma from the recirculating channel through the return filter.
The crossflow filtration apparatus may have a permeate channel arranged for concurrent flow of recirculating plasma with retentate flow therethrough. The permeate channel may have spaced structural members supporting the filter and a flat wall beneath each of them that define flow bottlenecks where most of the pressure drop along the permeate channel occurs.
According to embodiments, the disclosed subject matter includes a method of treating blood that includes determining a maximum shear rate based on a minimum shear rate causing damage to precious components of blood. Thus the flow rate may be selected so as to provide the highest rate that does not damage cells including a safety margin. The maximum shear rate thus lies below the minimum shear rate. The method includes determining a critical transmembrane pressure of a crossflow filter subjected to the maximum shear during crossflow filtration thereof. For blood processing the critical pressure may lie at a point where in spite of the shear, the flexible cells get trapped in pores of the crossflow filter causing a reduction in permeate rate through the filter and with constant volume flow, an accelerating transmembrane pressure that causes the entire filter to clog up. The critical transmembrane pressure causes an abrupt diminution in a relationship between flow across the crossflow filter and the applied transmembrane pressure, indicating a loss of efficiency of the crossflow filter throughput. The crossflow filter is configured to retain at least erythrocytes. The method includes crossflow filtering blood through a crossflow filter at an operating transmembrane pressure determined responsively to the critical transmembrane pressure to remove at least erythrocytes. The method includes ultrafiltering the permeate resulting from the crossflow filtering and returning ultrafiltered permeate and blood to a patient. The method further includes performing the foregoing crossflow filtering, ultrafiltering, and returning continuously for at least a day.
A flux rate of permeate passing through the crossflow filter may be between 0.5 and 2 ml/cm2 of filter area. The flow rate of permeate passing through the crossflow filter may be between 0.5 and 5 ml/min. The flow of ultrafiltrate in the ultrafiltering may be at a rate between 0.5 and 5 ml/min. The returning may include passing the permeate through a return filter to a venous return line. The crossflow filtering may include passing blood through a retentate channel with a depth of less than 500 microns. The crossflow filtering may include flowing a recirculating stream of permeate through a channel underlying a permeate side of the crossflow filter to generate a pressure drop through the channel that maintains the transmembrane pressure determined responsively to the critical transmembrane pressure. The rate of flow of permeate through the channel may be greater than a rate of flow of blood across a retentate side of the crossflow filter. The permeate may be substantially plasma. The ultrafiltering may produce a waste stream of water and aqueous solutes.
The crossflow filter may have a polished flat surface on a retentate side thereof. The crossflow filter may have an array of pores of 0.2 to 2.0 micron diameter. The crossflow filter may have pores whose depth may be not more than 5 times their diameters. The crossflow filter may be supported by structural members that restrict a flow of permeate across them to produce a stepwise pressure profile in a permeate channel underlying the crossflow filer. The crossflow filtering may be performed using a single crossflow filter whose area may be not more than 5 cm and a single retentate channel and a single permeate channel. The cross sectional area of a retentate channel overlying the crossflow filter may progressively diminish in a streamwise direction. The cross sectional area of a permeate channel underlying the crossflow filter may progressively expand in a streamwise direction. The width of a retentate channel overlying the crossflow filter may progressively diminish in a streamwise direction. The width of a permeate channel underlying the crossflow filter may progressively expand in a streamwise direction. The returning may include passing the permeate though a check valve. The returning may include passing the permeate through a return filter to a venous blood return line, wherein the crossflow filter and the return filter are arranged in a single module. The operating transmembrane pressure determined responsively to the critical transmembrane pressure may be determined responsively to a minimum shear rate required to sweep erythrocytes from a retentate side of the crossflow filter at a given transmembrane pressure.
The crossflow filtering may be effective to sweep erythrocytes from a retentate side of the crossflow filter at the operating transmembrane pressure. The crossflow filtering may include flowing retentate and permeate concurrently on both sides of the crossflow filter. The retentate may flow across the crossflow filter in a rectangular channel having an aspect ratio of at least ten.
According to embodiments, the disclosed subject matter includes a method of treating blood that includes determining a maximum shear rate based on a minimum shear rate causing damage to precious components of blood, where the maximum shear rate lies below the minimum shear rate. The method includes determining a critical transmembrane pressure of a crossflow filter subjected to the maximum shear during crossflow filtration thereof. The critical transmembrane pressure is one which causes an abrupt diminution in a relationship between flow across the crossflow filter and the applied transmembrane pressure, indicating a loss of efficiency of the crossflow filter throughput. The crossflow filter is configured to retain at least erythrocytes. The crossflow filtering blood through a crossflow filter is controlled to be at an operating transmembrane pressure determined responsively to the critical transmembrane pressure to remove at least erythrocytes therefrom. The method includes processing the permeate resulting from the crossflow filtering and returning processed permeate and blood to a patient. The method further includes performing the foregoing crossflow filtering, processing, and returning continuously for at least a day.
According to further embodiments, the processing may include adsorbing, ultrafiltering, dialyzing, hemofiltering, or hemodiafiltering the permeate. The flux rate of permeate passing through the crossflow filter may be between 0.5 and 2 ml/cm2 of filter area. The flow rate of permeate passing through the crossflow filter may be between 0.5 and 5 ml/min.
The returning may include passing the permeate through a return filter to a venous return line. The crossflow filtering may include passing blood through a retentate channel with a depth of less than 500 microns. The crossflow filtering may include flowing a recirculating stream of permeate through a channel underlying a permeate side of the crossflow filter to generate a pressure drop through the channel that maintains the transmembrane pressure determined responsively to the critical transmembrane pressure. The rate of flow of permeate through the channel may be greater than a rate of flow of blood across a retentate side of the crossflow filter. The permeate may be substantially plasma. The ultrafiltering may produce a waste stream of water and aqueous solutes.
The crossflow filter may have a polished flat surface on a retentate side thereof. The crossflow filter may have an array of pores of 0.2 to 2.0 micron diameter. The crossflow filter may have pores whose depth may be not more than 5 times their diameters. The crossflow filter may be supported by structural members that restrict a flow of permeate across them to produce a stepwise pressure profile in a permeate channel underlying the crossflow filer. The crossflow filtering may be performed using a single crossflow filter whose area may be not more than 5 cm and a single retentate channel and a single permeate channel. The cross sectional area of a retentate channel overlying the crossflow filter may progressively diminish in a streamwise direction. The cross sectional area of a permeate channel underlying the crossflow filter may progressively expand in a streamwise direction. The width of a retentate channel overlying the crossflow filter may progressively diminish in a streamwise direction. The width of a permeate channel underlying the crossflow filter may progressively expand in a streamwise direction. The returning may include passing the permeate though a check valve. The returning may include passing the permeate through a return filter to a venous blood return line, wherein the crossflow filter and the return filter are arranged in a single module. The operating transmembrane pressure determined responsively to the critical transmembrane pressure may be determined responsively to a minimum shear rate required to sweep erythrocytes from a retentate side of the crossflow filter at a given transmembrane pressure.
The crossflow filtering may be effective to sweep erythrocytes from a retentate side of the crossflow filter at the operating transmembrane pressure. The crossflow filtering may include flowing retentate and permeate concurrently on both sides of the crossflow filter. The retentate may flow across the crossflow filter in a rectangular channel having an aspect ratio of at least ten.
According to embodiments, the disclosed subject matter include a method for extracorporeal treatment of blood, comprising: flowing whole blood at a primary flow rate from a patient in a crossflow filter and extracting as permeate, a plasma flow with a volume fraction of the whole blood flow of 1 to 25 percent and returning a reduced flow of blood, resulting from the extracting, back to the patient. The method includes recirculating the plasma flow to the crossflow filter at a rate effective to moderate a change in transmembrane pressure across the crossflow filter and controlling a tonicity of the recirculating plasma flow to a level above that of the whole blood. The controlling includes continuously returning hypertonic plasma to the patient at a predefined extraction rate removing water and uremic toxins from the recirculating plasma at a predetermined ultrafiltration rate.
The predefined extraction rate may be between 10 and 75 percent of a rate of flow of permeate. The predefined extraction rate may be between 30 and 70 percent of a rate of flow of permeate. The predefined extraction rate may be between 40 and 60 percent of a rate of flow of permeate. The predefined ultrafiltration rate may be between 10 and 75 percent of a rate of flow of permeate. The predefined ultrafiltration rate may be between 30 and 70 percent of a rate of flow of permeate. The predefined ultrafiltration rate may be between 40 and 60 percent of a rate of flow of permeate. The rate of permeate flow may be between 5 and 25 percent of the primary rate. The rate of permeate flow may be between 10 and 20 percent of the primary rate. The crossflow filter may have a pore size between 400 and 800 nm. The flowing whole blood may be effective to immobilize red blood cells on a retentate side of the crossflow filter. The crossflow filter may have a regular array of unlinked, non-branching, pores each of which may have an aspect ratio of length to diameter of less than 5. The crossflow filter may have a regular array of unlinked, non-branching, pores each of which may have an aspect ratio of length to diameter of less than 2. The tonicity of the recirculating plasma flow may be between 1.5 and 5 times that of the whole blood.
According to embodiments, the disclosed subject matter include a method for treating blood of a patient including extracting plasma from whole blood from the patient to form a flow of freshly extracted plasma. The method includes ultrafiltering the freshly extracted plasma to produce a flow of dewatered plasma. The method includes directly combining the freshly extracted plasma with the dewatered plasma and flowing the combined freshly extracted and dewatered plasma back to the patient. The flowing the combined freshly extracted plasma may include further dewatering the combined freshly extracted and dewatered plasma back and then flowing a fraction thereof back to the patient while retaining a fraction as dewatered plasma to be combined with freshly extracted plasma.
The directly combining may include generating a flow in a crossflow filter channel that moderates a streamwise change in transmembrane pressure along a retentate side of a crossflow filter used in the extracting plasma. The extracting may include flowing the blood in a microfluidic channel whose height is no more than 500 microns in depth. The microfluidic channel may be on a retentate side of a crossflow filter and the extracting may be at a rate of 1 to 5 ml/min. The microfluidic channel may be on a retentate side of a crossflow filter and the extracting may be at a rate of at least 1 ml/min-cm2 of filter area.
In any of the foregoing method, system, or apparatus embodiments, the cross flow filter may be further limited to filters whose pore spacing is such that a layer of immobilized cells may be separated by such a distance that the immobilized cells can protect the patency of pores that are not blocked. If the spacing is too wide, then no adjacent cells can keep other cells from blocking neighboring cells. Thus, in treating blood according to the disclosed embodiments, a pore spacing that permits cells trapped in pores to protect other pores from being blocked may be desirable in embodiments.
It is, thus, apparent that there is provided, in accordance with the present disclosure, methods, devices, and systems for fluid separation. Many alternatives, modifications, and variations are enabled by the present disclosure. Features of the disclosed embodiments can be combined, rearranged, omitted, etc., within the scope of the invention to produce additional embodiments. Furthermore, certain features may sometimes be used to advantage without a corresponding use of other features. Accordingly, Applicants intend to embrace all such alternatives, modifications, equivalents, and variations that are within the spirit and scope of the present invention.
This application claims the benefit of U.S. Provisional Application No. 61/544,913, filed 7 Oct. 2011, and U.S. Provisional Application No. 61/635,370, filed 19 Apr. 2012, the disclosures of both of which are hereby incorporated by reference herein in their entireties.
This invention was made with U.S. government support under RO1 HL038306 awarded by the National Institutes of Health—National Heart, Lung, and Blood Institute; and under NIH 528801 awarded by the National Institutes of Health (NIH). The U.S. government has certain rights in the invention.
Filing Document | Filing Date | Country | Kind | 371c Date |
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PCT/US12/59247 | 10/8/2012 | WO | 00 | 3/11/2014 |
Number | Date | Country | |
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61544913 | Oct 2011 | US | |
61635370 | Apr 2012 | US |