高ビリルビン血症とアフェレシス(<特集>肝・膵疾患とアフェレシス)

概要

論文の詳細を見る
In Japan, apheresis has been widely applied to treat patients with hyperbilirubinemia, despite reports so far that the outcome is somewhat equivocal. In this article, the pathogenesis and pathophysiology of jaundice, and the clinical efficacy and limitation of apheresis were reviewed not only from the use of literature but also the author's personal experience. The introduction of apheresis can be a reasonable approach, if it is aimed to adjust what has produced jaundice because bilirubin per se has not been found to be definitely toxic as long as its blood level remains in the clinical range. The amelioration of jaundice should be the secondary result either by the resolution of fundamental etiology or by the restoration of morbidity. The author's experience unfortunately does not yet support such rationale of this modality. Furthermore, even if it is focused on the efficiency of bilirubin removal, apheresis therapy(plasma exchange as well as plasma sorption) does not seem to fulfill such aim in the second place. This is because bilirubin has a large pool in the extra-vascular space, resulting in a rapid rebound in the blood level soon after treatment.
日本アフェレシス学会の論文
1997-10-31