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[Successful treatment of an infant with fulminant hepatitis by factor VII concentrate]
Insights
Fulminant hepatitis in infants can lead to severe coagulopathy. Combination therapy with exchange transfusion and Factor VII concentrate effectively managed coagulation abnormalities without side effects.
Area of Science:
- Hepatology
- Pediatric Gastroenterology
- Hematology
Background:
- Neonatal Hepatitis B infection can lead to severe liver disease.
- Maternal Hepatitis B carrier status necessitates prophylactic measures for newborns.
- Fulminant hepatitis presents with rapid liver failure and coagulopathy.
Observation:
- A 2-month-old infant presented with poor sucking, jaundice, and altered consciousness.
- Laboratory findings revealed elevated liver enzymes, bilirubin, ammonia, and prolonged coagulation times.
- Standard exchange transfusion improved biochemical parameters but not hypocoagulable states.
Findings:
- Factor VII activity was found to decrease most rapidly after exchange transfusion.
- Alternate therapy with exchange transfusion and Factor VII concentrate improved coagulation abnormalities.
- This combined approach demonstrated no adverse side effects.
Implications:
- Combination therapy of exchange transfusion and Factor VII concentrate may be a viable treatment for fulminant hepatitis.
- This approach offers a potential solution for managing uncontrollable coagulopathy in severe hepatitis.
- Further research is warranted to validate the efficacy and safety of this combined therapeutic strategy.
Abstract:
A 2-month-old boy was admitted to our hospital because of poor sucking and jaundice. There were no abnormalities during the whole period of pregnancy and at birth. His mother was a HBeAb positive HBsAg carrier, but prophylactic maneuver such as anti-HB immunoglobulin and HB vaccine was not performed on him at birth. Physical examination on admission revealed mild disturbance of consciousness. The laboratory findings showed marked increments of serum bilirubin, GOT, GPT, and NH3, and prolongation of prothrombin time, activated partial thromboplastin time and hepaplastin test. Thus, he was diagnosed as fulminant hepatitis and treated with exchange transfusion once or twice a day. Biochemical data improved gradually, but hypocoagulable states remained unchanged. At that time we decided to use Factor VII concentrate, because we found that, among several coagulation factors, factor VII activity decreased most rapidly after exchange transfusion. The alternate therapy of exchange transfusion and Factor VII concentrate improved his coagulation abnormality without any side effects. Our experience suggests that the combination therapy of exchange transfusion and Factor VII concentrate may be useful for management of fulminant hepatitis, particularly for uncontrollable coagulopathy.