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Assuming that this works (which I will do for the point of this conversation, not that I believe it): 1. You'd have to create a bunch of hemo-irradiators (whic
by carbocation 6y ago
Assuming that this works (which I will do for the point of this conversation, not that I believe it):
1. You'd have to create a bunch of hemo-irradiators (which don't currently exist).
2. You'd have to train perfusionists or nurses to use them.
3. You'd have to place large-bore dialysis-style catheters into patients for the purpose of using these devices.
4. You'd have to have 1:1 RN staffing to use these machines (just like we do for continuous veno-venous hemofiltration devices for renal failure patients in the ICU).
Lots of downstream things to think about beyond just whether the concept is feasible.
- ryanmarsh 6y agoDon’t forget the infection risk.
- carbocation 6y agoProponents: "Don't worry, that secondary bacterial bloodstream infection due to vascular access will also be cured by this machine"
- tinus_hn 6y agoJust insert some tide pods in the machine.
- sova 6y agoGiven that one only needs to recirculate 5-7% of the blood and expose it to UV C, could we not shrink this age-old device into something portable? I don't know anything about phlebotomy or the implications of liquid pressure in the body, but it seems like if you can administer a syringe you can draw blood, UV it, and put it back in as well.
- carbocation 6y agoThe clotting cascade will not be friendly to that approach.
- sova 6y agoThank you, that makes sense!
- Consultant32452 6y agoI wonder if a simpler model could be done. When donating plasma your blood is cycled through some machine that removes the plasma and then your red blood cells are pumped back into your body. It's about the same as donating blood as far as pain/invasiveness. While it would take some doing, it seems pumping your blood around a UV light source has GOT to be simpler than removing the plasma. Yes, you still have to make the machine, but intuitively it doesn't seem super complicated.
- numpad0 6y agoMore like dialysis I think?
- LorenPechtel 6y agoMake the machine? Take an ordinary plasma donation machine, insert a UV irradiation gizmo into the blood path somewhere. Obviously not ideal but it could be built much faster.
- Consultant32452 6y agoThat should work as long as you can reasonably disable the plasma collection bit. If you're sick you probably want to keep that.
- rsynnott 6y agoI mean, to be clear, this is not a treatment for covid. No-one is suggesting that.
- sroussey 6y agoWell, maybe the president of the United States is...
- squarefoot 6y agoHence the need to find around something that when appropriately distorted by biased media will make some of Trump's statements (exposing Covid-19 patients to UV) appear more legit to the uninformed, so that the whole "inject disinfectants" thing can be conveniently buried. The paper is old, let's see how many news sources will magically remember about it to turn it into a PR stunt.
- SketchySeaBeast 6y agoWell, not no-one.
- burmer 6y agoAt least one person was suggesting it https://www.nytimes.com/2020/04/24/health/sunlight-coronavirus-trump.html https://www.nytimes.com/2020/04/24/health/sunlight-coronavir...
- HumblyTossed 6y agoDon't forget, he also suggested injecting disinfectant.
- rsynnott 6y agoIt’s extremely doubtful that this obscure anti-bacterial technique is what he was talking about; he was probably just confused by reporting on UV room sterilisation, which is a real, effective, practice, but not suitable for humans unless you’re not fussy about whether they survive.
- new299 6y agoI assume by “works” you mean in relation to COVID19? Sars-Cov2 is a respiratory disease. I guess it maybe present in blood, but it doesn’t seem like removing it from blood would help with the respiratory issues it causes. I can’t see how you would easily get UV light into the lungs. But maybe there’s a way... seems a bit far fetched.
- rabuse 6y agoIt could be part of the intubation process, if the patient is already that bad. Just theorizing.
- giarc 6y agoThe problem is the lungs are an incredible network of tunnels. If you spread out the surface area of your lungs, they would cover a tennis court (something I heard a long time ago, likely not exactly correct but generally right). You could get UV light to the large bronchi but you couldn't get UV light into all the million little aveoli.
- whatshisface 6y agoClaims about the surface area of fractals are almost always true if generally interpreted. If you went down to the atomic scale you could probably calculate that the surface area of your lungs would cover the Earth. :)
- btilly 6y agoThe fractal structure of the lung ends with relatively smooth tissue after a finite amount of branching. So the usual arguments about fractals notwithstanding, there actually is a finite area to discuss that makes sense.
- whatshisface 6y agoSure, but if you look closer you will see that all of the cells have holes for stuff to go in and out, and the proteins sticking up from the surface have shapes, and so on. That's why I said "the atomic scale" not "the microscopic scale."
- medymed 6y agoI also don't think this approach would be helpful, but regarding these points. 1. Photopheresis units already exist but would require some modification for whole blood irradiation rather than wbc only. 2. There are (a limited number of) nurses 3. Catheters are routinely placed 4. Most photopheresis units don't have 1:1 staff, but for ICU patients the situation may be different
- carbocation 6y agoRe: staffing - I agree that there is a difference between plasmapheresis (which is reasonable to monitor a few people at once) and ICU care (which, at least at my institution, we generally rely on 1:1 staffing for devices that circulate blood outside of the body). Re: catheters - agreed that they are routinely placed, but they're morbid and we don't do it unless necessary. Generally we use a different type of catheter for recirculation vs a standard central line, so this probably can't be piggy-backed on what is already going to be placed in the ICU.
- beerandt 6y agoIs there a reason everyone presumes in-situ/ closed-loop treatment is required, other than that is what the paper discussed? It seems like an artificial constraint, or maybe just the convenient method to use for research. Why not: Remove whole blood, treat whole blood (possibly in bulk with other patients' bags of blood), replace whole blood. It would address most of what you list, and otherwise simplify things, especially if only a small % of blood needs to be treated.
- rogerkirkness 6y agoThis sounds like ECMO or less invasive ECMO.
- beerandt 6y agoNo- that's the opposite direction I was trying to describe. Not a closed loop system. Draw, treat, replace. Whole blood drawn into a bag as if you were donating, then treated separately (maybe even sent to a lab), and then transfused back into the patient. The closed loop systems are what create a lot of the complication and expense. ECMO (or similar) definitely doesn't simplify anything.
- duxup 6y agoHow feasible is it to just....take out all the blood, treat it, and return it? Wouldn't there be some residual blood with a virus or whatever you want to stop? Would that actually be easier to do?
- eternauta3k 6y agoIt's not about sterilizing the blood.
- koheripbal 6y agoThe blood is typically not where the virus or bacteria are concentrated. Also, "treating" the blood would also destroy red and white blood cells which we need to survive. ...not to mention the 10^6 other proteins, antibodies, and many unknown structures in the blood. ...things we'd be breaking that we don't even know what they do yet.
- pharrington 6y ago"Michael Hamblin is a Principal Investigator at the Wellman Center for Photomedicine at Massachusetts General Hospital" - http://wellman.massgeneral.org/faculty-hamblin-pi.htm http://wellman.massgeneral.org/faculty-hamblin-pi.htm
- dombesz 6y agoHmm, what about just treat people by exposing them to sunlight daily? Am I missing something?
- burnte 6y agoYes. When you remove the blood from the body and expose it to UV, you're exposing the pathogens in the blood directly to UV. When the blood is still inside the body, UV can't reach it, it's blocked by the skin. Also, that causes sunburns.
- hawkice 6y agoBlood is on the inside, and skin isn't transparent to UV.
- chelovek89 6y agoStudies from the 1918 influenza outbreak show that patients treated partially outside had better outcomes https://medium.com/@ra.hobday/coronavirus-and-the-sun-a-lesson-from-the-1918-influenza-pandemic-509151dc8065 https://medium.com/@ra.hobday/coronavirus-and-the-sun-a-less... https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4504358/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4504358/
- Cass 6y agoThey suggest treating only 5-7% of the blood, which is 250 - 350 ml. It's still going to be an elaborate procedure, but a lot less so than hemodialysis, which moves much larger volumes of blood. You wouldn't even need a large-bore catheter, and keeping the blood pressure stable would be far less of a concern, so you probably don't have to do it 1:1.
- whoanow 6y agoCouldn't you treat the blood within the body? Find a high flow, easily accessibly blood vessel and inject a thin fiber optic cable connected to a uv laser?
- phonethrowaway 6y agoNadal cavity. Already exists...
- jjtheblunt 6y agoBeing outdoors in sunlight would realize UV blood irradiation through skin capillaries?
- nomel 6y agoIf you have dark skin, certainly not. The whole point of having dark skin is so the UV doesn't make its way into your flesh, where it can wreak havoc.
- ogre_codes 6y agoThis kind of care is only available for very wealthy people. Which explains why the current administration sees it as a viable treatment.