Rapid plasma exchange in a young man with idiopathic (autoimmune) thrombocytopenic purpura and life-threatening hæmorrhage acutely increased the platelet-count and enhanced hæmostasis. The patient had not responded to steroids, and massive intra-abdominal bleeding had developed after splenectomy, despite numerous platelet transfusions. After plasma exchange, his hæmoglobin concentration became normal without further transfusion and his abdominal girth decreased. Therefore emergency reoperation because of intra-abdominal bleeding was no longer required. A cumulative-sums plot of his platelet-count confirmed that plasmapheresis on 2 occasions was followed by a pronounced rise in mean platelet-count. Neither prednisone nor vincristine therapy altered the slope of the plot. The high initial anti-platelet antibody concentration in this patient fell after plasma exchange. These findings indicate that plasmapheresis accelerated clearance of circulating anti-platelet factors in fulminant idiopathic thrombocytopenic purpura.
Bibliographical noteFunding Information:
This work was supported by grants from the National Leukemia As- sociation, Inc., and the National Institutes of Health (CA20251 and AM15730). R.F.B. is a special fellow of the Leukaemia Society of America, Inc. Requests for reprints should be addressed