Plasma Exchange: A new ray of hope for failing liver - A Sir Ganga Ram Hospital Case Report

A 52-year-old male patient was admitted to Sir Ganga Ram Hospital,  New Delhi with symptoms of jaundice since 2 weeks followed by altered consciousness  He further developed ascites which basically is the accumulation of fluid in the abdomen and decreased urine output. On further investigations, he was detected to be hepatitis B Virus positive and hence a diagnosis of acute on chronic liver failure secondary to Hepatitis B virus reactivation was made.

Plasmapheresis is increasingly being used as a bridge for liver transplant and in many cases a large proportion of these patients may recover by the control of other factors. Like in our patient treatment of Hepatitis B virus with medication was continued. So in this situation PLEX acted as support to the failing liver.

PLEX is a procedure like hemodialysis where the blood is removed from the patient and the cellular components (RBC, WBC, and platelet) are separated from plasma by centrifugation in the machine. The plasma is discarded and fresh plasma (FFP) and albumin is mixed along with the cellular components and returned back to the patient. The plasma contains a lot of toxic products which are being produced the injury to liver. Since in PLEX entire plasma is removed so all the toxic products are removed as compared to dialysis and MARS where the removal is limited by the pore size.

The cost of PLEX for every session is around 30,000 INR and blood donors are required. On an average in patients who respond undergo 3 sessions of PLEX and some may require more session like our patient required 5 sessions.

In this particular patient it proved to be lifesaving and provided time for other treatment to take its effect.

In this video, Dr. Piyush Ranjan, Vice-Chairman and Senior consultant at the Department of Gastroenterology at Sir Ganga Ram Hospital, New Delhi talks about how Plasma Exchange gives a new ray of hope for failing liver.