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February 6, 1967

Treatment of Hepatic Coma With Exchange Transfusion and Peritoneal Dialysis

Author Affiliations

From the Department of Medicine, Denver General Hospital. Dr. Krebs is now at Fitzsimons General Hospital, Denver.

JAMA. 1967;199(6):430-432. doi:10.1001/jama.1967.03120060128032

HEPATIC COMA, when associated with acute viral hepatitis, has a high mortality rate,1 and the usual methods of therapy2 are helpful only when the coma is due to some exogenous factor such as gastrointestinal hemorrhage which precipitates decompensation of the injured liver. Any therapeutic technique which will improve the general condition of the acutely ill patient with hepatitis may procure the time necessary for liver regeneration. Hepatic coma due to acute viral hepatitis has recently been successfully treated by exchange transfusion with fresh, heparinized blood.3,4 Since fresh blood is at times difficult to obtain in the necessary quantities, it would be of value if this procedure could be safely performed with stored acid-citrate-dextrose (ACD) blood.

The following case report illustrates the course of a patient with acute hepatitis treated successfully with exchange transfusion. Stored ACD blood, with an average age of about seven days, was used. In