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Sept 18, 1967

Exchange Transfusion for Massive Liver Necrosis

JAMA. 1967;201(12):983. doi:10.1001/jama.1967.03130120091038

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To the Editor:—  Within the past five months, we have cared for five patients with acute hepatic coma occurring as a result of massive hepatic necrosis. This letter is written to relate our experiences because of considerable current interest in the treatment of this problem.Exchange transfusions were performed in four of the patients, of whom one survived. He is a 48-year-old white man who ingested a pint of carbon tetrachloride in a suicide attempt and became comatose four days later. His peak serum glutamic pyruvic transaminase (SGOT) was > 6,500 units and peak prothrombin time 30 seconds ( 12 second control). He received an exchange transfusion of 6 liters of whole blood and awoke 27 hours later at a time when his prothrombin time was 26 seconds and bilirubin level was climbing. Additional therapy included neomycin but no steroids. The other three patients who did not survive had the following