title: [Plasma exchanges as treatment of severe acute immune thrombocytopenic purpura].
abstract: BACKGROUND
  High dose steroids and intravenous immunoglobulins are the gold treatment of acute immune thrombocytopenic purpura, before splenectomy for severe and refractory forms of the disease. Authors report two cases of severe acute refractory immune thombocytopenia with a dramatic response to plasma exchanges.
  
  
  METHODS
  The first case was an idiopathic form, complicated by hemorragic peritoneal effusion. After failure of steroids, intravenous immunoglobulins and splenectomy and 2 courses of rituximab, plasmapheresis normalized in 3 days platelet count. In the second observation, ITP was associated to systemic lupus with antiphospholipids antibodies and multivisceral failure, despite steroids and intravenous immunoglobulins. After 3 plasma exchanges, platelet count was normalized, and the patient is under remission after 24 months follow-up.
  
  
  CONCLUSIONS
  Plasmapheresis must be evaluated as an emergency treatment in refractory forms of acute immune thrombocytopenic purpura.
authors.affiliation: Service de médecine interne (Pr Planchon), CHU Hôtel-Dieu, Place Alexis-Ricordeau, Nantes 44093 Nantes cedex, France.
authors.forename: A
authors.initials: A
authors.lastname: Masseau
authors.forename: C
authors.initials: C
authors.lastname: Guitton
authors.forename: C
authors.initials: C
authors.lastname: Bretonnière
authors.forename: B
authors.initials: B
authors.lastname: Renard
authors.forename: D
authors.initials: D
authors.lastname: Villers
authors.forename: M
authors.initials: M
authors.lastname: Hamidou
mesh_terms: D000208:Acute Disease; D000328:Adult; D005260:Female; D006801:Humans; D010956:Plasmapheresis; D010976:Platelet Count; D011696:Purpura, Thrombocytopenic / Q000097:blood / Q000628:therapy*; D012074:Remission Induction; D013997:Time Factors; D016896:Treatment Outcome