Successful treatment of hepatic coma by exchange transfusions

Hepatic coma developed in a 25-year-old Negro woman with serum hepatitis 24 days after admission. The patient deteriorated and became moribund despite therapy with g'ucose administered intravenously, neomycin sulphate, large doses of steriods, and careful attention to electeolyte balance. Four days later exchange transfusions were begun. She received 5 pt of properly matched blood treated with heparin sodium the first day; 10 pt the second day, and 8 units the third day. Twelve hours after the last exchange, the patient dramatically awoke from her coma and subsequently recovered completely. We believe that exchange transfusions played a significant role in the result obtained and recommend its early use in hepatic coma resulting from fulminating hepatitis.