Abstract
A hemodialysis patient with fulminant hepatitis type A was successfully treated with plasma exchange (PE) and hemodiafiltration (HDF) using a highly permeable membrane (FB-130U®). A 62-year-old woman, who was treated with hemodialysis for 2 years, was admitted to our hospital due to severe general fatigue and icterus. Laboratory examinations on admission included; ALT 157IU/l, AST 185IU/l, ammonia 58μg/dl, total bilirubin 7.6mg/dl, and prothrombin time 84%. Her consciousness became disturbed. Since hepatitis type A viral antibody was positive, she was diagnosed as having fulminant hepatitis due to type A hepatitis. On the 19th hospital day, plasma exchange and hemodiafiltration were started using a highly permeable membrane (FB-130U®). A total of 7.2l of plasma was exchanged by 3 courses of PE (2.4l) and 80l of filtrate was replaced by 10 courses of HDF (4hours).
After starting these procedures, her consciousness level became clear, and on 39th hospital day, she returned to conventional hemodialysis treatment. Since the bleeding tendency was severe, liver biopsy was not performed. Thus, the concomitant treatments of PE with HDF are considered effective for a fulminant course of hepatitis A in hemodialysis patients.
