Masseau A, Guitton C, Bretonnière C, Renard B, Villers D, Hamidou M
Service de médecine interne (Pr Planchon), CHU Hôtel-Dieu, Place Alexis-Ricordeau, Nantes 44093 Nantes cedex, France.
Rev Med Interne. 2005 Oct;26(10):824-6. doi: 10.1016/j.revmed.2005.06.009. Epub 2005 Aug 9.
High dose steroids and intravenous immunoglobulins are the gold treatment of acute immune thrombocytopenic purpura, before splenectomy for severe and refractory forms of the disease. Authors report two cases of severe acute refractory immune thombocytopenia with a dramatic response to plasma exchanges.
The first case was an idiopathic form, complicated by hemorragic peritoneal effusion. After failure of steroids, intravenous immunoglobulins and splenectomy and 2 courses of rituximab, plasmapheresis normalized in 3 days platelet count. In the second observation, ITP was associated to systemic lupus with antiphospholipids antibodies and multivisceral failure, despite steroids and intravenous immunoglobulins. After 3 plasma exchanges, platelet count was normalized, and the patient is under remission after 24 months follow-up.
Plasmapheresis must be evaluated as an emergency treatment in refractory forms of acute immune thrombocytopenic purpura.
在对严重和难治性急性免疫性血小板减少性紫癜进行脾切除术之前，大剂量类固醇和静脉注射免疫球蛋白是其黄金治疗方法。作者报告了两例严重急性难治性免疫性血小板减少症患者，血浆置换对其有显著疗效。
第一例为特发性形式，并发出血性腹腔积液。在类固醇、静脉注射免疫球蛋白和脾切除术均失败以及两疗程利妥昔单抗治疗后，血浆置换在3天内使血小板计数恢复正常。在第二项观察中，尽管使用了类固醇和静脉注射免疫球蛋白，但免疫性血小板减少症与伴有抗磷脂抗体的系统性红斑狼疮及多脏器衰竭相关。经过3次血浆置换后，血小板计数恢复正常，患者在随访24个月后处于缓解状态。
对于难治性急性免疫性血小板减少性紫癜，血浆置换应作为一种紧急治疗方法进行评估。
