Finn Laura, Tun Han
Mayo Clinic, Jacksonville, FL, United States.
Transfus Apher Sci. 2013 Dec;49(3):661-4. doi: 10.1016/j.transci.2013.06.019. Epub 2013 Jul 12.
Refractory immune-mediated thrombocytopenia (ITP) can be very difficult to manage, especially if associated with a hemorrhagic or surgical emergency. We report two cases of refractory ITP that were unresponsive to routine therapeutic interventions and frequent platelet transfusions. A combination of plasma exchange and platelet transfusion successfully raised the platelet count to a level that permitted life-saving surgical interventions. Plasma exchange in these two cases likely reduced platelet antibodies significantly, decreasing platelet destruction. We propose that a trial of combination plasma exchange and platelet transfusion can be attempted in emergent thrombocytopenic situations with an underlying immune mechanism.
难治性免疫性血小板减少症（ITP）可能极难处理，尤其是在伴有出血或外科急症的情况下。我们报告了两例难治性ITP病例，它们对常规治疗干预措施和频繁的血小板输注均无反应。血浆置换与血小板输注相结合成功地将血小板计数提高到了允许进行挽救生命的外科手术的水平。这两例病例中的血浆置换可能显著减少了血小板抗体，从而减少了血小板破坏。我们建议，对于存在潜在免疫机制的急性血小板减少情况，可尝试进行血浆置换与血小板输注联合治疗的试验。
