One‐Year Follow‐Up of Plasma Exchange Therapy in 14 Patients with Idiopathic Thrombocytopenic Purpura
One‐Year Follow‐Up of Plasma Exchange Therapy in 14 Patients with Idiopathic Thrombocytopenic Purpura
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DOI：
10.1046/j.1537-2995.1981.21381201800.x
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发表时间：
1981-05
期刊：
影响因子：
2.9
通讯作者：
VJ Marder;J. Nusbacher;FW Anderson
中科院分区：
文献类型：
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作者：
VJ Marder;J. Nusbacher;FW Anderson
对14例特发性血小板减少性紫癜（ITP）患者进行血浆置换治疗，随访1年。在9例急性ITP患者中有8例在脾切除术前进行交换，在5例慢性ITP患者中进行脾切除术后进行交换。没有一个慢性ITP患者在血小板计数方面表现出交换治疗的反应。9例急性ITP患者中有4例反应不佳，由于持续严重血小板减少症而需要脾切除术。其中3例已完全缓解，正在缓解中。1例急性ITP患者的反应不明确，最近的血小板计数为93，000/μl。其余4例急性ITP患者有迅速和完全的反应，现在血小板计数超过100，000/μl，无需类固醇治疗。虽然良好的反应与使用血浆而非白蛋白存在时间相关性，但数据不足以得出必须输注血浆因子才能获得满意结果的结论。一年后的总体反应与接受泼尼松和早期脾切除术治疗的急性ITP患者的预期反应大致相同。交换血浆置换术可能对减少需要脾切除术的患者数量有价值，但需要进行随机前瞻性研究以充分评估这种可能性。
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/μl. The remaining four patients with acute ITP had prompt and complete responses and now have platelet counts above 100,000/μl 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.