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Nine patients with acute fulminant hepatic necrosis with stage 4 coma have been subjected to plasmapheresis with plasma exchange. Two emerged from coma only to die from pulmonary complications. Despite improving hepatic function and regeneration of hepatocytes, all patients died of extrahepatic complications. Postmortem studies of one patient (case 7), utilizing immunofluorescent tagging techniques, demonstrated Australia antigen (HAA) in all tissues studied, including liver, brain, heart, lung, ovary, spleen and kidney. Fulminant viral hepatitis is a systemic disease with multiple organ involvement. Therapy should be directed not only to the liver but should include measures designed to combat systemic effects of the

Erythrokinetic studies on two anephric and asplenic patients are described. The patients were nephrectomized in preparation for renal homotransplantation and maintained on hemodialysis for six and eight months. Results of these studies indicate that despite absence of kidneys and spleen, and intrinsic base line erythropoietic activity remains, with a relatively constant and persistent reticulocyte production and radioiron turnover. Autonomy of this erythropoietic activity was apparent by lack of responsiveness to induced anemia and polycythemia. In the second patient a reticulocytosis and increased iron turnover occurred five months postnephrectomy. This was accompanied by significant plasma titers of erythropoietin-like substance. A renin-like enzyme was also found in the plasma of both patients. These observations suggest the existence of an autonomous base line erythropoietic activity of bone marrow and a possible functional relationship between inappropriate secretion of extrarenal "erythropoietin" and extrarenal "renin."