A Case Report of Pediatric Fulminant Hepatitis Treated With Plasma Diafiltration

Abstract

Plasma diafiltration (PDF) is blood purification therapy in which simple plasma exchange is performed with a membrane plasma separator while dialysate flows outside the hollow fibers. A 14-year-old boy with fulminant hepatitis underwent two sessions of PDF and one session of hemodiafiltration. We infused filtered replacement fluid for artificial kidneys at a dialysate flow rate of 600 mL/h and a replacement flow rate of 450 mL/h. We infused fresh frozen plasma (1200 mL) and 25% albumin solution (50 mL) intravenously over 8 h. Each PDF session lasted 8 h. The patient's total bilirubin, interleukin-18, and cystatin C levels decreased with treatment, and he recovered from hepatic failure. PDF may be an extremely useful blood purification therapy for pediatric fulminant hepatitis in terms of both medical economics and cytokine removal.

Multicenter Study of Plasma Diafiltration in Patients With Acute Liver Failure

“…We have previously reported on the effectiveness of PDF in patients with acute liver failure (7–9). Here, we report the results of a prospective multicenter trial using PDF in patients with liver failure.…”

Role of plasma exchange, leukocytapheresis, and plasma diafiltration in management of refractory macrophage activation syndrome

“…The Evacure EC‐2 A plasma separator has a pore size of .01 mm, which is much smaller than that of the standard plasma separation membrane (0.2–0.4 mm). This membrane has a sieving coefficient of 0.3 for albumin and thus can selectively remove low or intermediate molecular weight albumin‐bound substances . In addition, coagulation factors are preserved in the process because this membrane has a sieving coefficient of 0 for fibrinogen .…”

“…Plasma diafiltration (PDF) is a blood purification therapy in which simple PE is performed using a selective membrane plasma separator (Evacure EC‐2 A plasma separator; Kuraray, Tokyo, Japan) while the dialysate flows outside the hollow fibers . PDF has some advantages compared with PE.…”

Plasma Adiponectin Levels in Acute Liver Failure Patients Treated with Plasma Filtration with Dialysis and Plasma Exchange

“…This membrane has a sieving coefficient of 0.3 for albumin and thus can selectively remove low‐ or intermediate‐molecular‐weight albumin‐bound substances. In addition, coagulation factors are preserved because this membrane has a sieving coefficient of 0 for fibrinogen and IgM . Li et al reported that PE with a membrane pore size of 0.03 μm adequately removed bilirubin and bile acid, a class of toxins bound to plasma protein in patients with severe viral hepatitis, and reduced the loss of essential plasma macromolecules .…”