The Canadian Experience Using Plasma Exchange for Immune Thrombocytopenic Purpura

The effect of plasma exchange (PE) for the treatment of acute immune thrombocytopenic purpura (ITP) was assessed both through an analysis of the use of PE for ITP in Canada from 1980 to 1997, and in a study of 23 patients with acute ITP. Thirteen of these 23 patients were treated by PE (10 were exchanged with albumin and three with FFP) plus prednisone and 10 were treated with prednisone alone. At the 6 month follow-up, 11 of 19 patients were considered complete responders and six were considered partial responders. The difference in response rates between the PE and prednisone groups was not statistically significant. All patients had platelet specific antibodies at the time of entry into the study. Antibody concentration was reduced following PE in 10 of the 12 patients tested, and a response to PE was seen in all 10 patients who had a reduction in the level of platelet antibody. In contrast, antibody levels did not change in the patients who received steroid treatment only. This observation suggests that antibody removal may be of direct benefit in patients with ITP. Analysis of our results indicated that PE increased the length of time before splenectomy but did not alter the need for splenectomy. Short term benefits of PE were accomplished with no increase in morbidity or mortality which confirms that PE is a safe procedure in patients with ITP.