One‐Year Follow‐Up of Plasma Exchange Therapy in 14 Patients with Idiopathic Thrombocytopenic Purpura

Abstract

Fourteen patients with idiopathic thrombocytopenic purpura (ITP) have been followed for one year after plasma exchange therapy. Exchange was performed prior to splenectomy in eight of nine patients with acute ITP and following splenectomy in five patients with chronic ITP. None with chronic ITP showed a response in platelet count as a result of exchange therapy. Four of the nine with acute ITP had poor responses and required splenectomy because of persistent severe thrombocytopenia. Three of these have responded completely and are in remission. One patient with acute ITP had an equivocal response, with a most recent platelet count of 93,000/microliter. The remaining four patients with acute ITP had prompt and complete responses and now have platelet counts above 100,000/microliter without steroid treatment. Although the good responses were temporally associated with the use of plasma but not albumin, the data are not sufficient to conclude that a plasma factor must be infused to obtain a satisfactory result. The overall response after one year was about that expected for acute ITP patients treated with prednisone and early splenectomy. Exchange plasmapheresis may be of value in decreasing the number of patients who require splenectomy, but a randomized, prospective study is needed to adequately assess this possibility.

Phase 2 study of efgartigimod, a novel FcRn antagonist, in adult patients with primary immune thrombocytopenia

“…For those patients, a rise in platelet counts was only observed after the fourth infusion (day 22), which could indicate that either a more profound autoantibody reduction is needed, and/or that the main pathogenic action of the autoantibodies consists of impairing platelet production by the megakaryocytes in the bone marrow. 45 Most patients who responded to efgartigimod had a transient Patients benefited at both doses tested, further supporting the IgG reduction hypothesis. Additionally, some patients demonstrated a double platelet peak following efgartigimod treatment, as exemplified in Figure S7C, suggesting two distinct pathogenic autoantibody mechanisms with different kinetics.…”

CT cross‐sectional imaging classification system for substernal goiter based on risk factors for an extracervical surgical approach

“…For steroid‐refractory disease, gamma‐globulin can be transiently effective in up to 90% of patients but yields only a 10% long‐term response 23. Similar short‐term responses have been demonstrated with plasma exchange 24, 25. Splenectomy is definitive therapy for refractory ITP with an efficacy of 50% to 65% 1.…”

Role of Plasmapheresis in Thrombocytopenic Purpura Associated With Waldenström's Macroglobulinemia

“…Anecdotal evidence suggests that it may be of value in producing prolonged remissions and may postpone the need for splenectomy in patients with acute ITP. 3 Chronic ITP is believed to be less responsive, and the role of plasmapheresis in patients with this variant remains undefined.…”