A case of tiopronin-induced intrahepatic cholestatic hepatitis

treatment of hyperbilirubinemia by selective plasma exchange

Abstract

We have developed a new plasma exchange therapy by means of the membrane type plasma component separator Evaflux 2A, by which free and albumin-bound bilirubin in the blood can be selectively removed. We conducted this therapy on a patient with refractory intrahepatic cholestatic hepatitis supposed to be induced by Tiopronin and accompanied by hyperbilirubinemia which manifested six months ago, and we obtained good therapeutic results.
The removal rate of bilirubin by this procedure was about 21 per cent, and 70 per cent of the bilirubin removed was of the direct type. No change was observed in the total amount of protein, protein fractions, electrolytes in the blood before and after this therapy. Liquid chromatograpy showed that 86 per cent of the protein removed had smaller molecular weight than albumin.
The conventional plasma exchange therapies often cause serum hepatitis or abnormalities in electrolytes due to fresh frozen plasma (FFP), while absorption therapy using activated charcoal or IONEX can remove free bilirubin but not the other bilirubins. To solve these problems, we used 0.4 per cent albumin-added electrolyte solution instead of FFP in this therapy. As a result, this new therapy has permitted a relatively selective removal of bilirubin in the blood without causing complications due to FFP.