title: Long-term extracorporeal bilirubin elimination: A case report on cascade resin plasmaperfusion.
abstract: Acute hepatic failure develops as a disease entity of rather diverse origin. With disease progression, toxic bilirubin levels may cause severe complications which include AV-nodal blockage, cardiac arrhythmia, impaired consciousness, generalized seizures, and status epilepticus. Treatment choices to prevent clinical deterioration comprise of costly and limited available orthotopic liver transplantation, utilization of extracorporeal bioartificial liver support devices and haemoperfusion/plasmaperfusion treatment with activated charcoal/anion exchange filters. Here, we present a patient with acute drug-induced cholestatic hepatitis. Excessively elevated bilirubin levels were accompanied by cardiac and cerebral complications. Extracorporeal resin perfusion treatment (Plasorba, BR-350) was successfully performed over a 50-day period without activation of the coagulation system or side effects. Bilirubin levels were lowered to a minimum of 225 micromol/l, with concurrent clinical improvement. In conclusion, extracorporeal anion exchange plasmaperfusion may be a viable long-term treatment for hyperbilirubinaemic side effects in overt cholestatic hepatitis.
authors.affiliation: Medical Clinic II, University of Aachen, Germany.
authors.forename: P R
authors.initials: PR
authors.lastname: Mertens
authors.forename: T
authors.initials: T
authors.lastname: Schönfelder
authors.forename: S
authors.initials: S
authors.lastname: Handt
authors.forename: H
authors.initials: H
authors.lastname: Kierdorf
authors.forename: H
authors.initials: H
authors.lastname: Marschall
authors.forename: N
authors.initials: N
authors.lastname: Busch
authors.forename: B
authors.initials: B
authors.lastname: Heintz
authors.forename: H
authors.initials: H
authors.lastname: Sieberth
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications; D001647:Bile Acids and Salts / Q000097:blood; D002606:Charcoal; D056486:Chemical and Drug Induced Liver Injury / Q000150:complications*; D002779:Cholestasis / Q000097:blood / Q000139:chemically induced*; D004211:Disseminated Intravascular Coagulation / Q000150:complications; D004318:Doxycycline / Q000009:adverse effects; D004829:Epilepsy, Generalized / Q000209:etiology; D004917:Erythromycin / Q000009:adverse effects; D005112:Extracorporeal Circulation; D017809:Fatal Outcome; D006408:Hematoma, Subdural / Q000209:etiology; D006501:Hepatic Encephalopathy / Q000209:etiology / Q000628:therapy; D006801:Humans; D006932:Hyperbilirubinemia / Q000209:etiology / Q000628:therapy*; D017093:Liver Failure / Q000209:etiology / Q000628:therapy; D009853:Omeprazole / Q000009:adverse effects; D011014:Pneumonia / Q000209:etiology; D011899:Ranitidine / Q000009:adverse effects; D012116:Resins, Plant; D012772:Shock, Septic / Q000209:etiology; D013924:Thrombophlebitis / Q000150:complications
chemical_list: D001647:Bile Acids and Salts; D012116:Resins, Plant; D002606:Charcoal; D004917:Erythromycin; D011899:Ranitidine; D009853:Omeprazole; D004318:Doxycycline