title: Plasma exchange in combination with online-hemodiafiltration as a promising method for purifying the blood of fulminant hepatitis patients.
abstract: BACKGROUND
  Fulminant hepatitis is an intractable disease caused by various etiological agents. Artificial liver support (ALS) is a symptomatic treatment used to control serious symptoms, such as bleeding tendency, hepatic coma, and brain edema.
  
  
  METHODS
  The present study involved four patients with fulminant hepatitis who were admitted to Showa University Fujigaoka Hospital between January 2007 and June 2007. All four patients were subacute type disease of indeterminate etiology. The four patients were placed on an ALS system that comprised plasma exchange and online hemodiafiltration. The effect of the ALS on various symptoms of fulminant hepatitis was evaluated, and the levels of glutamine in the patients' plasma samples and the discarded buffer were assayed using automatic analyser.
  
  
  RESULTS
  Three of the four patients regained full consciousness and survived. The remaining patient died despite recovering from hepatic coma with ALS. The plasma glutamine levels were significantly reduced by artificial liver support. The estimated distribution volume of removed Gln ranged from 30 L to 60 L.
  
  
  CONCLUSIONS
  Plasma exchange in combination with online hemodiafiltration is a promising and effective method for purifying the blood of patients with fulminant hepatitis.
authors.affiliation: Division of Gastroenterology, Showa University Fujigaoka Hospital, Yokohama, Japan.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Inoue
authors.forename: Akishi
authors.initials: A
authors.lastname: Kourin
authors.forename: Tsunamasa
authors.initials: T
authors.lastname: Watanabe
authors.forename: Masaya
authors.initials: M
authors.lastname: Yamada
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yasuda
authors.forename: Makoto
authors.initials: M
authors.lastname: Yoshiba