Abstract
Although plasma exchange and hemoperfusion have been generally applied for the treatment of fulminant hepatic failure, complications such as thrombocytopenia induced by hemoperfusion and serum hepatitis induced by plasma exchange have been reported. To prevent these complications, we performed plasma perfusion (PP) for the treatment of fulminant hepatitis. Blood obtained by femoral vein cannulation at a flow rate of 150ml/min was separated by a plasma separator (Asahi Medical Co.) at a rate of 30ml/min and separated plasma was passed through a coated charcoal column (Sumitomo Bakelite Co., CR-300 or CR-200, Japan Medical Supply Co., Bespore®) with a pump at a flow rate of 400ml/min. Seven patients with fulminant hepatitis and mild to moderate hepatic encephalopathy were treated with PP. The efficacy of PP was evaluated by improvements in clinical signs, laboratory parametess such as serum bilirubin and amino acid analysis. The removal rate of bilirubin by PP was 22.9±5.2%, which was not significantly different from that achieved by plasma exchange, 35.9±3.7%. The platelet count before and after PP did not show any significant change. The minimum requirement of anticoagulant, heparin, was 4, 000 units, which was much less than that in hemoperfusion. Increment of the plasma flow rate through the charcoal column did not affect whole-body hemodynamics. Consciousness levels evaluated according to the classification of Scherlock was improved in all cases without any case of multiorgan failure after surgery. Three out of seven patients survived without any complications. Fisher score, which is the ratio of branched amino acids to aromatic amino acids, increased gradually during PP. A comparison of aromatic amino acid concentration before and after passage through the column revealed that aromatic amino acids were removed dramatically, about 77 to 80% by a single passage. From these results, we concluded that plasma perfusion with a plasma separator and charcoal column might be a better manuever for treating fulminant hepatitis in comparison with either plasma exchange or hemoperfusion.
