{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T01:38:55Z","timestamp":1789609135694,"version":"build-2803163510"},"reference-count":32,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2017,8,9]],"date-time":"2017-08-09T00:00:00Z","timestamp":1502236800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J of Clinical Apheresis"],"published-print":{"date-parts":[[2018,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Intractable pruritus of cholestasis leads to significant morbidity. Therapeutic plasma exchange (TPE) has been shown to be an effective alternative in the setting of refractory pruritus associated with cholestatic liver disease based on several individual reports. Due to rarity of this approach to intractable pruritus, the literature is sparse and therefore TPE, as a treatment for refractory pruritus is currently not in the apheresis guidelines. We present three additional patients with severe intractable pruritus of cholestasis successfully treated with plasma exchange to add to the mounting literature showing this as an effective and safe adjunctive therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Three patients underwent serial plasma exchange procedures to control pruritus. Frequency of plasma exchange was three times a week, with slow taper upon improvement of pruritus. Total bile acid levels were assessed before procedures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>All three patients had an intractable pruritus with different underlying etiologies of cholestasis. All three patients showed significant improvement in pruritus, with none or minimal pruritus in one patient with primary biliary cirrhosis. Pre procedure bile acids levels were decreased initially, but showed rebound increase upon tapering of plasma exchange, without increased pruritus. No serious side effects or complications were observed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our results in conjunction with the published literature show that severe and intractable pruritus associated with cholestasis could be successfully treated with TPE, irrespective of the underlying disease, and can be done safely.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jca.21573","type":"journal-article","created":{"date-parts":[[2017,8,9]],"date-time":"2017-08-09T06:56:39Z","timestamp":1502261799000},"page":"412-418","source":"Crossref","is-referenced-by-count":17,"title":["Plasma exchange for the management of refractory pruritus of cholestasis: A report of three cases and review of literature"],"prefix":"10.1002","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5679-0692","authenticated-orcid":false,"given":"Rati","family":"Chkheidze","sequence":"first","affiliation":[{"name":"Department of Pathology University of Texas Southwestern Medical Center Dallas TX 75390"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ranjit","family":"Joseph","sequence":"additional","affiliation":[{"name":"Department of Pathology University of Texas Southwestern Medical Center Dallas TX 75390"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Burner","sequence":"additional","affiliation":[{"name":"Department of Pathology University of Texas Southwestern Medical Center Dallas TX 75390"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Matevosyan","sequence":"additional","affiliation":[{"name":"Department of Pathology University of Texas Southwestern Medical Center Dallas TX 75390"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,8,9]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-3046.2011.01603.x"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0b013e318297e384"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/213093b0"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2010.05.009"},{"key":"e_1_2_6_6_1","volume-title":"Itch: Mechanisms and Treatment","author":"Bergasa NV.","year":"2016"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.26909"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cld.2012.03.010"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2009.04.009"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-82-3-310"},{"issue":"3","key":"e_1_2_6_11_1","first-page":"158","article-title":"A trial of ademetionine in the treatment of intrahepatic biliary stasis viral hepatitis","volume":"8","author":"Qin B","year":"2000","journal-title":"Zhonghua Gan Zang Bing Za Zhi."},{"issue":"1","key":"e_1_2_6_12_1","first-page":"69","article-title":"A review of the studies on the clinical use of S\u2010adenosylmethionine (SAMe) for the symptomatic treatment of intrahepatic cholestasis","volume":"12","author":"Coltorti M","year":"1990","journal-title":"Methods Find Exp Clin Pharmacol."},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.5863\/1551-6776-18.3.241"},{"key":"e_1_2_6_14_1","first-page":"Cd008320","article-title":"Pharmacological interventions for pruritus in adult palliative care patients","volume":"11","author":"Siemens W","year":"2016","journal-title":"Cochrane Database Syst Rev."},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2010.02.031"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1478-3231.2011.02584.x"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2012.04.023"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2006.08.008"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.20998"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2012.04.008"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v23.i19.3418"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1155\/2008\/969826"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.transci.2013.07.002"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1097\/00004836-198910000-00011"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.26.3.291"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/00004836-198606000-00021"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/0955-3886(91)90130-U"},{"key":"e_1_2_6_28_1","first-page":"233","article-title":"Therapeutic plasmapheresis for cholestatic liver diseases: study of 9 cases","volume":"337","author":"Omokawa S","year":"1990","journal-title":"Prog Clin Biol Res."},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v13.i30.4152"},{"key":"e_1_2_6_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2005.01.048"},{"key":"e_1_2_6_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.13281"},{"issue":"6","key":"e_1_2_6_32_1","first-page":"239","article-title":"Treatment of intractable pruritus in patients with cholestatic jaundice by plasma exchange and plasma perfusion","volume":"21","author":"Geerdink P","year":"1978","journal-title":"Neth J Med."},{"issue":"1","key":"e_1_2_6_33_1","first-page":"128","article-title":"Effects of plasma exchange (PE) in primary biliary cirrhosis (PBC). A pilot study","volume":"37","author":"Surrenti C","year":"1990","journal-title":"Hepatogastroenterology."}],"container-title":["Journal of Clinical Apheresis"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fjca.21573","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jca.21573","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,17]],"date-time":"2023-09-17T19:33:13Z","timestamp":1694979193000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jca.21573"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,8,9]]},"references-count":32,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2018,6]]}},"alternative-id":["10.1002\/jca.21573"],"URL":"https:\/\/doi.org\/10.1002\/jca.21573","archive":["Portico"],"relation":{},"ISSN":["0733-2459","1098-1101"],"issn-type":[{"value":"0733-2459","type":"print"},{"value":"1098-1101","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,8,9]]}}}