Treatment of intra-heptic cholestasis in primary biliary cirrhosis by long term plasmapheresis

Two female patients with grade IV primary biliary cirrhosis, untractable pruritus, arthralgias and xanthomatous neuropathy in one case, underwent long term plasmapheresis for 30 months (on a continuous centrifugation cell separator) and 18 months (on capillary plasma filters). Plasma exchange were performed monthly and substitution achieved by diluted human serum albumin. No major side effect occurred. Pruritus, arthralgias and xanthomatous neuropathy greatly improved or even disappeared. The plasma levels of transaminases, albumin, globulin and clotting factors were stable, alkaline phosphatases slightly diminished. Bilirubin, after an initial fall at 6 months, increased again. Cholesterol stabilized at near normal values. Bile acids blood levels decreased in both cases.