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Plasmapheresis with Plasma Exchange in Hepatic Coma: Methods and Results in Five Patients with Acute Fulminant Hepatic Necrosis

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We are indebted to the New York Blood Center for their cooperation and for providing generous supplies of plasma and plasma products used in this study.

Presented in part April 23, 1969, at the Fiftieth Annual Session of the American College of Physicians, in Chicago, Ill.; and in November 1968, as part of the Annual Alumni Lecture, University of Rochester School of Medicine, Rochester, Minn.

▸Requests for reprints should be addressed to Michael J. Lepore, M.D., St. Vincent's Hospital and Medical Center, 153 W. 11th St., New York, N.Y. 10011.

New York, New York

Ann Intern Med. 1970;72(2):165-174. doi:10.7326/0003-4819-72-2-165
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Five patients with acute fulminant hepatic necrosis with coma were subjected to vigorous, massive, and prolonged plasmapheresis with plasma exchange on the theory that removal of the patient's plasma would eliminate or reduce circulating noxious protein-bound factors responsible for coma and that replacement of the patient's plasma with fresh frozen human plasma would support the patient through the critical period required for hepatocyte regeneration. One of the five patients emerged from stage IV coma on day 6 and another on day 8 of vigorous plasmapheresis and appeared to be recovering until severe and relentless bronchopneumonia led to their deaths. The technique can be conducted in humans without undue risk and is more practicable and more in keeping with the pathology of hepatic necrosis than pig liver bypass, human cadaver liver bypass, or cross-circulation with humans, baboons, or chimpanzees.





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