Volume 14 Supplement 1

30th International Symposium on Intensive Care and Emergency Medicine

Open Access

Therapeutic plasma exchange in children with acute liver failure: assessment of laboratory parameters

  • D Demirkol1,
  • O Yanar1,
  • N Gerenli1,
  • A Citak1,
  • I Ozden1,
  • S Cantez1,
  • O Durmaz1 and
  • M Karabocuoglu1
Critical Care201014(Suppl 1):P510

https://doi.org/10.1186/cc8742

Published: 1 March 2010

Introduction

The aim of this study is to analyze the effect of therapeutic plasma exchange (TPE) on biochemical and coagulation parameters.

Methods

We enrolled all children who were admitted to the pediatric ICU with diagnosis of acute liver failure and underwent TPE between December 2005 and December 2009. Serum prothrombin time, International Normalized Ratio, total and direct bilirubin, aminotransferases and serum ammonia values were recorded before and after TPE sessions.

Results

Fourteen patients (male/female, 4/10, median age 8.5 years) underwent a total of 37 TPE sessions. Acute liver failure was induced by viral hepatitis in five cases, Wilson disease in four cases, toxins in four cases and autoimmune hepatitis in one case. When compared with baseline, there were significant improvements in laboratory parameters (Table 1). Five of the 14 patients (35.7%) died in the pediatric ICU, five patients underwent liver transplantation. Four patients (28.5%) survived with extracorporeal liver support. No serious adverse effect of TPE was observed in the patients during or after completion of TPE.
Table 1

Biochemical and coagulation parameters before and after TPE

Variable

Before TPE

After TPE

Delta variable

P value

PT (sec)

40.9 (32.5 to 47.5)

21.1 (18.1 to 25.0)

17.8 (10.2 to 26.1)

0.0003

INR

3.6 (3.1 to 4.6)

1.7 (1.5 to 2.3)

1.7 (1.3 to 27.8)

0.0002

TB (mg/dl)

17.7 (11.7 to 21.5)

14.2 (9.6 to 18.0)

3.2 (1.1 to 6.0)

0.0006

DB (mg/dl)

10.3 (7.3 to 17.2)

7.9 (4.8 to 14.2)

1.9 (0.8 to 4.8)

0.0001

ALT (U/l)

122.5 (61.1 to 370)

87.5 (54 to 197.5)

38.1 (7 to 109.5)

0.0001

AST (U/l)

247.5 (122 to 399)

178 (85.5 to 272)

66.5 (14.1 to 223)

0.0002

Ammonia (mmol/l)

143.2 (81.5 to 195)

97.0 (71 to 150.5)

11.5 (3.5 to 59)

0.0003

Conclusions

TPE is effective in improving liver biochemistry tests in children with liver failure. Expected changes in laboratory parameters after TPE must be considered especially in deciding for liver transplantation.

Authors’ Affiliations

(1)
Istanbul University

References

  1. Singer AL, Olthoff KM, Haewen K, Rand E, Zamir G, Shaked A: Role of plasmapheresis in the management of acute hepatic failure in children. Ann Surg 2001, 234: 418-424. 10.1097/00000658-200109000-00015PubMedPubMed CentralView ArticleGoogle Scholar

Copyright

© BioMed Central Ltd. 2010

Advertisement