Combined plasma exchange and platelet transfusion in immune-mediated thrombocytopenic emergencies

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.