Value of plasmapheresis in hepatic encephalopathy

Riviello, James J.; Halligan, Gregory E.; Dunn, Stephen P.; Widzer, Steven J.; Foley, Catherine M.; Breningstall, Galen N.; Grover, Warren D.

doi:10.1016/0887-8994(90)90006-m

Cited by 9 publications

(2 citation statements)

References 14 publications

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“…The use of combined therapeutic plasmapheresis and renal replacement therapy is occasionally necessary for the treatment of patients with immune-mediated renal disease [1], sepsis [2], fulminant hepatic failure [3,4], and thrombotic thrombocytopenic purpura (TTP) /hemolytic uremic syndrome (HUS) [5][6][7][8][9][10]. Providing centrifugation plasmapheresis to patients receiving renal replacement therapy is usually uncomplicated, as most are treated with either hemodialysis or peritoneal dialysis.…”

Section: Introductionmentioning

confidence: 99%

Concurrent centrifugation plasmapheresis and continuous venovenous hemodiafiltration

Yorgin¹,

Eklund

Al-Uzri³

et al. 2000

Pediatric Nephrology

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Continuous venovenous hemofiltration/hemodiafiltration (CVVH/D) is commonly used to provide renal replacement therapy for critically ill patients who are hemodynamically unstable. Occasionally, the addition of plasmapheresis therapy is necessary for some conditions, including immune-mediated acute renal failure, sepsis, fulminant hepatic failure, and thrombotic thrombocytopenic purpura/hemolytic uremic syndrome. Most tertiary care facilities provide centrifugation plasmapheresis instead of membrane plasmapheresis, because of the requirement for both therapeutic plasma exchange and pheresis of cellular blood products. We report a new technique where centrifugation plasmapheresis and CVVHD (P-CVVHD) are combined and used concurrently. Blood from the patient was concurrently filtered utilizing a Hospal BSM 22 machine with a Multiflow 60 hemofilter and a Cobe Spectra continuous cell separator in a parallel configuration. P-CVVHD is technically possible and can be used for long periods of time with limited risks. There may be advantages to P-CVVHD compared with discontinuous combined CVVH/D and plasmapheresis therapy.

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Section: Introductionmentioning

confidence: 99%

Concurrent centrifugation plasmapheresis and continuous venovenous hemodiafiltration

Yorgin¹,

Eklund

Al-Uzri³

et al. 2000

Pediatric Nephrology

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“…It appears effective in restoring homeostasis, improving neurological function, and prolonging biochemical stability of patients with fulminant hepatic failure [32][33][34][35][36][37].…”

Section: Discussionmentioning

confidence: 99%

Fulminant hepatic failure associated with propylthiouracil: A case report with treatment emphasis on the use of plasmapheresis

et al. 2005

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Propylthiouracil is a commonly used medication for hyperthyroidism. Though propylthiouracil-induced hepatotoxicity is a rarely encountered problem, death due to fulminant hepatic failure may occur. In the English literature, only 34 cases have been described with severe hepatotoxicity secondary to this drug. Here we report a case of fulminant hepatic failure due to propylthiouracil and review the issues of treatment and management with special emphasis on the use of plasmapheresis in such situations.

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Plasma separation for artificial liver support

Lepage¹,

Lane²,

McKay³

et al. 1995

J of Clinical Apheresis

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A bioartificial liver (BAL) support system, using plasma separation, has been developed to support acute liver failure patients. This study examined 14 consecutive BAL treatments in nine patients with severe acute liver failure. We report methods to achieve and manage plasma separation for an extended period of time. The mean duration of a BAL treatment was 435 minutes, with 26-59 liters of blood processed. Ionized hypocalcemia resulting in muscle twitching was a side effect of the therapy. Ionized calcium levels decreased significantly (P < .02) after BAL treatment; however, total calcium levels increased (P < .05). No significant changes were noted in heart rate, electrocardiogram [Q-T (Q-Tc) interval], blood pressure, prothrombin time, partial thromboplastin time, hematocrit, platelet count and serum phosphorous, magnesium, glucose, and pH. Plasma fibrinogen levels decreased significantly (P < .002). Ionized hypocalcemia due to the chelating effect of sodium citrate was controlled by calcium chloride administration, adjustment of blood separation rates, and reduction of the blood-to-citrate ratio. This report demonstrates that intensive, large-volume plasma separation for long periods of time can be achieved safely in critically ill patients without serious adverse effects.

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Value of plasmapheresis in hepatic encephalopathy

Cited by 9 publications

References 14 publications

Concurrent centrifugation plasmapheresis and continuous venovenous hemodiafiltration

Concurrent centrifugation plasmapheresis and continuous venovenous hemodiafiltration

Fulminant hepatic failure associated with propylthiouracil: A case report with treatment emphasis on the use of plasmapheresis

Plasma separation for artificial liver support

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