Blood purification in critical care, which includes simple plasma exchange, bilirubin adsorption, and plasma filtration with dialysis therapy, is often performed to treat hyperbilirubinemia in postoperative liver failure and multiple organ failure. However, there is little information regarding selective plasma exchange. Here, we investigated the removal efficiency of bilirubin removal by selective plasma exchange, in a patient with thrombocytopenia, anasarca, fever, renal failure or reticulin fibrosis, and organomegaly (TAFRO) syndrome. Selective plasma exchange was performed using Evacure Plus EC-4A10 as a selective membrane plasma separator. During selective plasma exchange, an increase of the processed plasma volume from 1,000mL to 4,000mL, caused only a slight change on the sieving coefficients of total, conjugated, and unconjugated bilirubin. The mean sieving coefficients of total, conjugated, and unconjugated bilirubin were 0.81±0.02, 0.90±0.01, and 0.49±0.06, respectively. The percent reduction of total bilirubin and fibrinogen following a session of selective plasma exchange was 40% and 3.7%, respectively. Selective plasma exchange can be performed to remove bilirubin while retaining coagulation factors, such as fibrinogen, even when an albumin solution is used as a replacement fluid.
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