Plasma Exchange in Autoimmune Thrombocytopenic Purpura

Abstract

We present data on 5 cases with autoimmune thrombocytopenic purpura treated with plasma exchange in whom conventional drug therapy had been ineffective. In 3, preparation for splenectomy allowed the operation to be performed without bleeding problems. 1 patient who was unfit for splenectomy underwent successful coronary artery vein grafting following preparation with plasma exchange. 2 patients were maintained for variable periods with intermittent exchanges, 1 prior to splenectomy and 1 post-splenectomy. In summary we had no prolonged response to plasma exchange but found it a useful technique as preparation for or adjunctive to more conventional therapy. It was also helpful in patients unresponsive to other forms of therapy who required a brief increase in platelet count to cover surgery or spontaneous haemorrhage.

Therapeutic plasma exchange practices in immune thrombocytopenia related hospitalizations: Results from a nationally representative sample

“…In this study, platelet‐specific antibody levels were significantly decreased in TPE patients, when compared to those receiving only prednisone, and this appeared to be related to response. Another small study found TPE to be a useful adjunct therapy in preparation for splenectomy, although its individual effects would not have been sufficient to hold off splenectomy 13 . A study conducted by Basturk et al found potential benefit for TPE in ITP patients when combined with first‐ and second‐line therapies, such as prednisone, splenectomy, IVIG, and rituximab; partial and complete responses were achieved in 41% and 52% of patients respectively 14 .…”

“…A study conducted by Basturk et al found potential benefit for TPE in ITP patients when combined with first‐ and second‐line therapies, such as prednisone, splenectomy, IVIG, and rituximab; partial and complete responses were achieved in 41% and 52% of patients respectively 14 . Some studies reported that TPE decreases the likelihood of needing splenectomy, while others have claimed that TPE should precede splenectomy as a preparative treatment 12,13 . In summary, current literature describes TPE use through small case series and case reports only.…”

“…Another small study found TPE to be a useful adjunct therapy in preparation for splenectomy, although its individual effects would not have been sufficient to hold off splenectomy. 13 A study conducted by Basturk et al found potential benefit for TPE in ITP patients when combined with first-and second-line therapies, such as prednisone, splenectomy, IVIG, and rituximab; partial and complete responses were achieved in 41% and 52% of patients respectively. 14 Some studies reported that TPE decreases the likelihood of needing splenectomy, while others have claimed that TPE should precede splenectomy as a preparative treatment.…”

“…14 Some studies reported that TPE decreases the likelihood of needing splenectomy, while others have claimed that TPE should precede splenectomy as a preparative treatment. 12,13 In summary, current literature describes TPE use through small case series and case reports only. The role of TPE in management of refractory ITP remains controversial.…”

Entscheidungshilfen zur Therapie der idiopathischen thrombozytopenischen Purpura (ITP) im Kindesalter

“…Bis zum Einsatz von Immunglobulinen war die Splenektomie bei Kindern mit chronischer ITP die Methode der Wahl. Aufgrund der geringen Zahl chronischer und intermittierender Verläufe (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) % nach Karpatkin (30» betraf diese Maßnahme nur wenige Kinder. Die Indikationen zur Splenektomie beschränken sich heute auf therapie resistente Thrombozytopenien (kein Ansprechen auf Kortikosteroide und/oder Immunglobuline) mit mehr als 6 Monaten Dauer (52,60), sowie solchen mit akuten lebensgefährlichen (z.B.…”