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Exchange Transfusion as Treatment of Acute Hepatic Failure Due to Antituberculosis Drugs

RICHARD J. LEDERMAN, M.D., PH.D.; FAITH B. DAVIS, M.D.; and PAUL J. DAVIS, M.D.
Ann Intern Med. 1968;68(4):830-838. doi:10.7326/0003-4819-68-4-830
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SUMMARY:

Successful exchange transfusion is reported for the fast time in a patient with drug-related hepatic failure and coma. Antituberculosis therapy with para-aminosalicylic acid and isoniazid was considered responsible for the fulminant hepatitis that was observed. Two successive exchange procedures, performed via indwelling arterial and venous Silastic catheters, were temporally related to the resolution of coma and normalization of prothrombin time. Before exchange the patient had received, without clinical improvement, high-dose corticosteroid therapy and a routine regimen for the management of hepatic coma. Her tuberculosis has been treated readily with secondary antituberculosis drugs. It is suggested that exchange transfusion be given further trials in patients with drug-related fulminant hepatic failure.

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