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- Plasma Exchange saves life of patient in dire need of liver transplant
- Huge economic benefit : liver Transplant cost Rs 30 lakhs where as Plasma exchange costs just 30,000
India
healthysoch
New Delhi, December 18, 2022:
A 52 year old male was admitted in Sir Ganga Ram Hospital, New Delhi with symptoms of jaundice since 2 weeks followed by altered consciousness . He further developed ascites (accumulation of fluid in abdomen and decreased urine output (acute kidney injury). On further investigations he was detected to be hepatitis B Virus positive and a diagnosis of with acute on chronic liver failure – (ACLF) secondary to Hepatitis B virus reactivation was made.
At this juncture dialysis was considered and patient was offered an option of liver transplant as his parameters indicated one month probability of survival to be around 50%.
According to Dr. Piyush Ranjan, Senior consultant, Department of Gastroenterology, Sir Ganga Ram Hospital, ”As there was no donor in the family we offered an unusual option of plasma exchange (PLEX). We did a total of five sessions of PLEX for him. After second session his jaundice started improving, his consciousness improved and renal functions also started improving. He was continued on other medical therapy of which the most important is anti-viral therapy. Patient was discharged after 20 days of hospitalization in a stable condition and one month of follow up his ascites (water in stomach) completely resolved and jaundice had normalized.“
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.
We are regularly offering PLEX to our patients with the most common indications being failed steroid treatment for severe alcoholic hepatitis and flare of hepatitis B and autoimmune hepatitis. We select these patients based on well established criteria. We have done 10 patients with good results and saved the need of high cost liver transplant which in today’s date costs around 25 to 30 lakhs in private sector.
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