Treatment with plasma exchange may serve benefical effect in patients with severe hyperbilirubinemia: A single center experience

Keklik, Muzaffer; Şıvgın, Serdar; Kaynar, Leylagül; Pala, Çiğdem; Çetın, Mustafa; Eser, Bülent; Ünal, Ali

doi:10.1016/j.transci.2013.04.009

Cited by 18 publications

(27 citation statements)

References 16 publications

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“…Not only that, it replenishes albumin, coagulation factors, and hepatic regenerative stimulating substances [46]. Plasmapheresis is mostly mentioned in the literature for the management of liver failure [46][47][48][49]. Keklik et al published their experience with plasma exchange as a treatment for patients with severe hyperbilirubinemia [48].…”

Section: Treatment and Outcomementioning

confidence: 99%

Bile cast nephropathy: when the kidneys turn yellow

2020

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Kidney injury is a common finding in patients with liver disease. Bile cast nephropathy (also known as cholemic nephropathy) is an overlooked cause of renal injury in patients with hyperbilirubinemia. It can occur as a result of the toxic effects of bilirubin and bile acids on the renal tubules via several mechanisms. Bile cast nephropathy has characteristic histopathological changes consisting of bilirubin cast deposition in the distal nephron along with tubular epithelial cell injury. Treatment is based on the reversal of liver injury. This review aims to describe bile cast nephropathy in terms of its clinical and morphological features and to shed light on diagnostic techniques. In addition, we present data on management of such nephropathy while reviewing all the reported cases of bile cast nephropathy.

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Section: Treatment and Outcomementioning

confidence: 99%

Bile cast nephropathy: when the kidneys turn yellow

2020

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“…Among the ALSS methods, nonbiological artificial liver (NBAL) is the most mature technique and used most frequently in clinical practice . Previous studies have confirmed NBAL combined with medical treatment can effectively improve the liver function and decrease the mortality in patients with liver failure . Plasma exchange (PE) is a widely used NBAL technique, which separates and discards the patient's plasma from the whole blood by a membrane‐type plasma separator and then supplements the same amount of fresh frozen plasma.…”

Section: Introductionmentioning

confidence: 99%

“…8,9 Previous studies have confirmed NBAL combined with medical treatment can effectively improve the liver function and decrease the mortality in patients with liver failure. 10,11 Plasma exchange (PE) is a widely used NBAL technique, which separates and discards the patient's plasma from the whole blood by a membrane-type plasma separator and then supplements the same amount of fresh frozen plasma. It can nonspecifically remove the medium-and small-molecule metabolic toxins, and it can also supplement the essential substances such as albumin and coagulation factors that are lacking in the patients, thus it can replace some functions of the liver.…”

Section: Introductionmentioning

confidence: 99%

Therapeutic effect of double plasma molecular adsorption system and sequential half‐dose plasma exchange in patients with HBV‐related acute‐on‐chronic liver failure

Yao

Zhou

et al. 2019

J of Clinical Apheresis

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Objective The artificial liver support system (ALSS) is used frequently as a first‐line treatment for hepatitis B virus‐associated acute‐on‐chronic liver failure (HBV‐ACLF). This study aims to compare the therapeutic efficacy of double plasma molecular adsorption system (DPMAS) with sequential half‐dose plasma exchange (PE) (DPMAS+PE) and full‐dose PE in patients with HBV‐ACLF. Methods A total of 131 hospitalized patients who were diagnosed with HBV‐ACLF and underwent DPMAS+PE or PE were retrospectively analyzed. According to the treatment methods used, they were divided into PE group (n = 77) and DPMAS+PE group (n = 54). The main evaluation indexes included the change of liver function and the 28‐days liver transplant‐free survival rates after the different treatments. Results There were no significant differences on severity of illness between PE group and DPMAS+PE group (P > 0.05). The total bilirubin (TBIL) levels immediately after treatment, and at 24 and 72 hours after treatment were markedly decreased in DPMAS+PE group than that in PE group (52.3 ± 9.4% vs 42.3 ± 7.2%, P < 0.05; 24.2 ± 10.0% vs 13.5 ± 13.0%, P < 0.05; 24.8 ± 13.1% vs 14.9 ± 14.9%, P < 0.05; respectively). The 28‐days survival rates was 62.3% and 72.2% in PE and DPMAS+PE groups (P = 0.146). Furthermore, the 28‐days survival rates were significantly higher in DPMAS+PE group than that in PE group (57.4% vs 41.7%, P = 0.043) in the intermediate‐advanced stage patients. Conclusion Compared with PE alone, DPMAS+PE might more effectively improve temporary TBIL in ACLF patients, and improve the 28‐days survival rates in HBV‐ACLF patients with intermediate‐advanced stage. Therefore, DPMAS+PE may be an available ALSS treatment for HBV‐ACLF patients.

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“…This was primarily prescribed to treat the severe hyperbilirubinemia. This technique has been infrequently utilized to manage hyperbilirubinemia in people for neonatal bilirubin encephalopathy, liver failure, leptospirosis, posthepatic bile duct obstruction, and hemolysis following implantation of a left ventricular assist device . Guidelines for the use of TPE with hyperbilirubinemia are available but are based on limited evidence and do not include recommendations on session intensity or frequency.…”

Section: Discussionmentioning

confidence: 99%

“…The average total bilirubin before treatment was 404 µmol/L (23.6 mg/dL) (range 192–770 µmol/L [11.2–45.0 mg/dL]). TPE sessions resulted in an average of 38% decrease in total bilirubin . The treatment intensity and frequency remains unclear for the management of hyperbilirubinemia.…”

Section: Discussionmentioning

confidence: 99%

Successful management of acute bilirubin encephalopathy in a dog with immune‐mediated hemolytic anemia using therapeutic plasma exchange

Heffner

Cavanagh

Nolan

2019

J Vet Emergen Crit Care

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Objective: To describe the successful management of acute bilirubin encephalopathy in a dog with immune-mediated hemolytic anemia (IMHA) treated with therapeutic plasma exchange (TPE) in conjunction with conventional medical management. Case Summary:A 6-year-old neutered male Australian Cattle Dog diagnosed with IMHA developed severe hyperbilirubinemia and stupor within the first 48 hours of implementing immunosuppressive therapy consisting of corticosteroids and mycophenolate. The patient received 4 blood transfusions during this period, but remained severely anemic PCV (18%) and experienced a subsequent increase in total bilirubin from 78 µmol/L (4.6 mg/dL) to a peak value of 1,563 µmol/L (91.4 mg/dL). The patient's neurological status rapidly deteriorated, resulting in lateral recumbency, vertical nystagmus, extensor rigidity, and stuporous mentation. Over the next 3 days, TPE was provided once every 24 hours, decreasing serum bilirubin, immunoglobulin G (IgG), and immunoglobulin M (IgM). The patient's red blood cell (RBC) transfusion requirements decreased immediately, requiring only 1 transfusion over the next 7 days that was required due to procedureassociated blood loss. Gradual neurological improvement was noted as serum bilirubin decreased. A brain magnetic resonance imaging (MRI) did not reveal any structural abnormalities and the patient was discharged after 11 days of hospitalization. Following discharge, the patient had complete remission of IMHA without any residual neurological deficits. Therapeutic plasma exchange played an integral role in case management and was successful in reducing bilirubin, IgG, and IgM. New or Unique Information Provided: Bilirubin encephalopathy has been rarely reported in small animal medicine and cases have been limited to postmortem documentation. This is the first suspected case of acute bilirubin encephalopathy in a dog that survived and describes the clinical course of disease. The kinetics of serum bilirubin, IgG, and IgM concentrations before and after TPE and throughout the hospitalization period are also described. K E Y W O R D Sanemia, canine, hyperbilirubinemia, plasmapheresis Abbreviations: IgG, immunoglobulin G; IgM, immunoglobulin M; IMHA, immune-mediated hemolytic anemia; MRI, magnetic resonance imaging; PO, per os; RBC, red blood cells; RI, reference interval; TPE, therapeutic plasma exchange; TPP, total plasma protein.

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Treatment with plasma exchange may serve benefical effect in patients with severe hyperbilirubinemia: A single center experience

Cited by 18 publications

References 16 publications

Bile cast nephropathy: when the kidneys turn yellow

Bile cast nephropathy: when the kidneys turn yellow

Therapeutic effect of double plasma molecular adsorption system and sequential half‐dose plasma exchange in patients with HBV‐related acute‐on‐chronic liver failure

Successful management of acute bilirubin encephalopathy in a dog with immune‐mediated hemolytic anemia using therapeutic plasma exchange

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