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Few authors reported on the use of total plasma exchange (TPE) in patients with the current definition of ACLF.
Hanto reported that there was no immunological graft loss using total plasma exchange, splenectomy, and quadruple immunosuppression [6], [38], [39], [40].
Although there are no randomized trials on the use of plasmapheresis in managing hyperviscosity, total plasma exchange (roughly 3 4 l in an adult, replaced with albumin rather than plasma) is repeated daily until normal serum viscosity is achieved and symptoms are relieved.
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Iron absorption from guts is in the range of 0.5 μg per day (calculated to whole-body scale from the data of Bahram et al. [ 36] and Lebeau et al. [ 21], whereas the rate of total plasma iron exchange with the body periphery is in the range 20-30 μg per day (Additional file 1: Table S8).
Median total plasma volume exchanged was 3750 mL (IQR 2500 6000), which corresponded to 1.5 (SD 0.9) times the individual plasma volume.
In total, 12 plasma exchanges were carried out, 5 mTPE and 7 cTPE.
A total of seven sessions of plasma exchange were carried out during the following several weeks.
A total of seven additional centrifugal plasma exchange procedures were performed with an average procedure time of 104 min. All seven cTPE procedures were uneventful and the prescribed dose was delivered on each occasion.
A total of 19 patients received plasma exchange, including 2 patients with TTP-HUS, 1 with catastrophic antiphospholipid antibody syndrome, 3 with lupus encephalopathy, 13 with severe crescentic glomerulonephritis, fibrinoid necrosis and thrombotic microangiopathy in renal pathological changes, and 26 patients received methylprednisolone pulse therapy.
He required a total of six plasma exchanges >10 days.
Treatment with pulse methylprednisolone (500 mg/day for 5 days), ATG (total of 7.5 mg/kg) along with plasma exchange (PE; eight treatments on an alternate day schedule) and IV immunoglobulin (100 mg/kg after each PE) was given.
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