A case report of pediatric fulminant hepatitis treated with plasma diafiltration.
Plasma diafiltration (PDF) is blood purification therapy in which simple plasma exchange is performed with a membrane plasma separator while dialysate flows outside the hollow fibers. A 14-year-old boy with fulminant hepatitis underwent two sessions of PDF and one session of hemodiafiltration. We infused filtered replacement fluid for artificial kidneys at a dialysate flow rate of 600 mL/h and a replacement flow rate of 450 mL/h. We infused fresh frozen plasma (1200 mL) and 25% albumin solution (50 mL) intravenously over 8 h. Each PDF session lasted 8 h. The patient's total bilirubin, interleukin-18, and cystatin C levels decreased with treatment, and he recovered from hepatic failure. PDF may be an extremely useful blood purification therapy for pediatric fulminant hepatitis in terms of both medical economics and cytokine removal.
Nakae
Hajime
H
Department of Integrated Medicine, and Emergency and Critical Care Medicine, Akita University School of Medicine, Akita, Japan. nakaeh@doc.med.akita-u.ac.jp
Igarashi
Toshiko
T
Tajimi
Kimitaka
K
Noguchi
Atsuko
A
Takahashi
Ikuko
I
Tsuchida
Satoko
S
Takahashi
Tsutomu
T
Asanuma
Yoshihiro
Y
D000293:Adolescent; D000418:Albumins / Q000627:therapeutic use; D001663:Bilirubin / Q000378:metabolism; D055316:Cystatin C; D015891:Cystatins / Q000378:metabolism; D017583:Hemodiafiltration / Q000379:methods*; D006509:Hepatitis B / Q000628:therapy*; D006801:Humans; D020382:Interleukin-18 / Q000378:metabolism; D017114:Liver Failure, Acute / Q000628:therapy*; D008297:Male; D010949:Plasma / Q000378:metabolism
D000418:Albumins; C525030:CST3 protein, human; D055316:Cystatin C; D015891:Cystatins; D020382:Interleukin-18; D001663:Bilirubin