Öz
Amaç: Bu retrospektif çalışmada
hiperbilirubinemiyi yönetme deneyimimizi sunmayı amaçladık.
Yöntem: Çalışmaya Sivas Cumhuriyet
Üniversitesi Tıp Fakültesi aferez ünitesinde 2006-2017 yılları arasında aferez
tedavisi alan 21 hiperbilirubinemili hasta alındı. Hastaların dosyaları
retrospektif olarak değerlendirildi ve şu veriler toplandı: hastanın yaşı,
cinsiyeti, semptomları, plazma değişimi sayısı, adjuvan tedavi yöntemleri, sıvı
replasmanı kullanımı, tedavi sonuçları ve plazma değişim komplikasyonları.
Bulgular: Hastaların yaş ortalaması 57 idi (dağılım; 18-82). Ortalama
plazma değişim sayısı 5,5'tir (aralık; 1-25). Sıvı değişimi için sadece taze
donmuş plazma kullanıldı. Plazma öncesi ve sonrası değişim bilirubin düzeyleri
arasında istatistiksel olarak anlamlı fark vardı (p <0.05). Toksik hepatit,
hasta popülasyonumuzda en sık görülen hiperbilirubinemi nedeni idi. Hastalar
plazma değişiminin yanı sıra, altta yatan durumuna uygun şekilde tedavi edildiler.
Komplikasyon olarak, 2 hastada(% 8.69) allerjik reaksiyon ve 3 hastada(% 13)
hipotansiyon gözlemledik.
Sonuç: Plazma değişimi, bilirubinin
uzaklaştırılması için güvenli bir yöntemdir. Ancak, plazma değişimi ve altta yatan durumun uygun
tedavisi ile birlikte azalan hiperbilirubinemi, tedavide birincil amaç
olmalıdır.
Anahtar Kelimeler
Kaynakça
- References1) Duan ZJ, Li LL, Ju J, et al. Treatment of hyperbilirubinemia with blood purification in China. World J Gastroenterol 2006; 12:7467-71.References2) Liu HB, Chen W, Dou KF, et al. Application of hemodialysis with plasma-based dialysate in patients with hyperbilirubinemia. J Nephrol Dialy Transplant 2004; 13:539- 43.References3) Nakae H, Yonekawa T, Narita K, et al. Are proinflammatory cytokine concentrations reduced by plasma exchange in patients with severe acute hepatic failure? Res Commun Mol Pathol Pharmacol 2001; 109:65-72.References4) Larsen FS, Schmidt LE, Bernsmeier C, Rasmussen A, Isoniemi H, Patel VC, et al. High-volume plasma exchange in patients with acute liver failure: An open randomised controlled trial. J Hepatol. 2016 Jan;64(1):69-78.References5) Shapiro SM, Definition of the clinical spectrum of kernicterus and bilirubin-induced neurologic dysfunction (BIND). J Perinatol 2005; 25:54-9.References6) Altıntaş E, Tombak A, Tellioğlu B, Ciddi hiperbilirubinemi nedenleri, tanı ve sağaltımı. Akademik gastroenteroloji dergisi 2010; 9(1):2-7.References7) Jin F, Cao M, Bai Y, et al. Therapeutic effects of plasma exchange for the treatment of 39 patients with acute fatty liver of pregnancy. Discovery Medicine 2012; 13:369-73.References8) Li M, Wang Z, Wang Y, Du C, Li S, Shi Z, et al. Part of plasmapheresis with plasma filtration adsorption combined with continuous hemodiafiltration in the treatment of severe acute liver failure. Exp Ther Med. 2016 Oct;12(4):2582-2584.References9) Nakamura T, Ushiyama C, Suzuki S, et al. Effect of plasma exchange on serum tissue inhibitor of metalloproteinase 1 and cytokine concentrations in patients with fulminant hepatitis. Blood Purif 2000; 18:50-4.References10) De Silvestro G, Marson P, Brandolese R, et al. A single institution's experience (1982-1999) with plasma-exchange therapy in patients with fulminant hepatic failure. Int J Artif Organs 2000; 23:454-61.References11) Ch'ng CL, Morgan M, Hainsworth I, et al. Prospective study of liver dysfunction in pregnancy in Southwest Wales. Gut 2002; 51(6):876-80.References12) Ho DW, Fan ST, To J, et al. Selective plasma filtration for treatment of fulminant hepatic failure induced by D-galactosamine in a pig model. Gut 2002; 50:869-76.References13) Shinozaki K, Oda S, Abe R, et al. Blood purification in fulminant hepatic failure. Contrib Nephrol 2010; 166:64-72. References14) Kamada N, Yoneyama K, Togawa Y, et al. Toxic epidermal necrolysis with severe hyperbilirubinemia: complete re-epithelialization after bilirubin reduction therapies. J Dermatol 2010; 37:534-6. References15) Chu YF, Meng M, Zeng J, et al. Effectiveness of combining plasma exchange with continuous hemodiafiltration on acute Fatty liver of pregnancy complicated by multiple organ dysfunction. Artif Organs 2012; 36:530-4.
Öz
Objective: In this retrospective study, we aimed to
present our experience of managing hyperbilirubinemia.
Method: Twenty three patients with
hyperbilirubinemia who received
apharesis treatment between 2006 and 2017 at the apheresis unit of
Cumhuriyet University School of Medicine were included in the study. Records of
the patients were evaluated retrospectively and the following data were
collected: patient’s age, sex, presenting symptoms, number of plasma exchange,
adjuvant treatment modalities, use of replacement fluid, treatment outcomes,
and plasma exchange complications.
Results: The median age of the patients was 57
years (range; 18-82). The median number of plasma exchange was 5,5 (range;
1-25). Fresh frozen plasma was the only replacement fluid used. There was
significant statistical differences between pre- and post-plasma exchange
bilirubine levels (p<0.05). Toxic hepatitis was the most common cause of
hyperbilirubinemia in our patient population. In addition to plasma exchange,
patients were treated with proper treatment of the underlying condition. We observed
allergic reactions 2 (8.69%) patients and hypotension in 3 (13%) patients
as complications
Conclusions: Plasma exchange
is a safe method for the elimination of bilirubin. However, diminishing
hyperbilirubinemia with plasma exchange together with the proper treatment of
the underlying condition should be the primary goal in management.
Anahtar Kelimeler
Kaynakça
- References1) Duan ZJ, Li LL, Ju J, et al. Treatment of hyperbilirubinemia with blood purification in China. World J Gastroenterol 2006; 12:7467-71.References2) Liu HB, Chen W, Dou KF, et al. Application of hemodialysis with plasma-based dialysate in patients with hyperbilirubinemia. J Nephrol Dialy Transplant 2004; 13:539- 43.References3) Nakae H, Yonekawa T, Narita K, et al. Are proinflammatory cytokine concentrations reduced by plasma exchange in patients with severe acute hepatic failure? Res Commun Mol Pathol Pharmacol 2001; 109:65-72.References4) Larsen FS, Schmidt LE, Bernsmeier C, Rasmussen A, Isoniemi H, Patel VC, et al. High-volume plasma exchange in patients with acute liver failure: An open randomised controlled trial. J Hepatol. 2016 Jan;64(1):69-78.References5) Shapiro SM, Definition of the clinical spectrum of kernicterus and bilirubin-induced neurologic dysfunction (BIND). J Perinatol 2005; 25:54-9.References6) Altıntaş E, Tombak A, Tellioğlu B, Ciddi hiperbilirubinemi nedenleri, tanı ve sağaltımı. Akademik gastroenteroloji dergisi 2010; 9(1):2-7.References7) Jin F, Cao M, Bai Y, et al. Therapeutic effects of plasma exchange for the treatment of 39 patients with acute fatty liver of pregnancy. Discovery Medicine 2012; 13:369-73.References8) Li M, Wang Z, Wang Y, Du C, Li S, Shi Z, et al. Part of plasmapheresis with plasma filtration adsorption combined with continuous hemodiafiltration in the treatment of severe acute liver failure. Exp Ther Med. 2016 Oct;12(4):2582-2584.References9) Nakamura T, Ushiyama C, Suzuki S, et al. Effect of plasma exchange on serum tissue inhibitor of metalloproteinase 1 and cytokine concentrations in patients with fulminant hepatitis. Blood Purif 2000; 18:50-4.References10) De Silvestro G, Marson P, Brandolese R, et al. A single institution's experience (1982-1999) with plasma-exchange therapy in patients with fulminant hepatic failure. Int J Artif Organs 2000; 23:454-61.References11) Ch'ng CL, Morgan M, Hainsworth I, et al. Prospective study of liver dysfunction in pregnancy in Southwest Wales. Gut 2002; 51(6):876-80.References12) Ho DW, Fan ST, To J, et al. Selective plasma filtration for treatment of fulminant hepatic failure induced by D-galactosamine in a pig model. Gut 2002; 50:869-76.References13) Shinozaki K, Oda S, Abe R, et al. Blood purification in fulminant hepatic failure. Contrib Nephrol 2010; 166:64-72. References14) Kamada N, Yoneyama K, Togawa Y, et al. Toxic epidermal necrolysis with severe hyperbilirubinemia: complete re-epithelialization after bilirubin reduction therapies. J Dermatol 2010; 37:534-6. References15) Chu YF, Meng M, Zeng J, et al. Effectiveness of combining plasma exchange with continuous hemodiafiltration on acute Fatty liver of pregnancy complicated by multiple organ dysfunction. Artif Organs 2012; 36:530-4.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Dahili Tıp Bilimleri Araştırma Yazıları |
| Yazarlar | |
| Yayımlanma Tarihi | 28 Mart 2019 |
| Kabul Tarihi | 26 Mart 2019 |
| Yayımlandığı Sayı | Yıl 2019 |