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 glucose administered intravenously, neomycin sulfate, large doses of steriods, and careful attention to electrolyte balance. Four days later exchange transfusions were begun. She received 5 pt. of properly matched blood treated with heparin sodium the 1st day; 10 pt. the 2nd day, and 8 units the 3rd day. Twelve hours after the last exchange, the patient dramatically awoke from her coma and subsequently recovered completely. We believe that exchange transufsions played a significant role in the result obtained and recommend its early use in hepatic coma resulting from fulminating hepatitis.