A case of advanced primary biliary cirrhosis treated with granulocyte and monocyte apheresis.
Generally, the most effective treatment for advanced primary biliary cirrhosis (PBC) is liver transplantation, but adjunct therapies are needed. We report here a first case of advanced PBC treated with a new immunotherapy, granulocyte and monocyte apheresis (GCAP). A column (Adacolumn, Japan Immunoresearch Laboratory Takasaki, Japan) was filled with cellulose acetate beads to selectively adsorb granulocytes and monocytes/macrophages. A 49-year-old woman was diagnosed with PBC in 1987. In June 2001, steroid pulse therapy and adjuvant fresh frozen plasma was given for moderate jaundice but without success. In July, as total bilirubin rapidly increased, treatment with GCAP was started and succeeded in suppressing the rapid deterioration of total bilirubin (value changes after each of four applications: 15.4-->14.0, 27.2-->25.1, 25.8-->24.0, 25.7-->23.7 mg/dL) and improving prothrombin time (16.4-->14.5 s). Although GCAP therapy did not prevent a fatal outcome, it suppressed rapid deterioration of jaundice and increased quality of life for a month.
Takegoshi
Kunio
K
Takegoshi Internal Medicine Clinic, Takaoka, Toyama, Japan. takegosh@bb.cocone.jp
Tohyama
Tatsuhiko
T
Okada
Eikichi
E
D001707:Biopsy, Needle; D001781:Blood Component Removal / Q000379:methods*; D018450:Disease Progression; D017809:Fatal Outcome; D005260:Female; D006098:Granulocytes; D006801:Humans; D007150:Immunohistochemistry; D008105:Liver Cirrhosis, Biliary / Q000473:pathology* / Q000628:therapy*; D008875:Middle Aged; D009000:Monocytes; D018570:Risk Assessment; D012720:Severity of Illness Index