title: Plasma exchange therapy for severe gastrointestinal involvement of Henoch Schönlein purpura in children.
abstract: OBJECTIVE
  The aim of this report is to evaluate the plasma exchange as a choice for the management of life-threating gastrointestinal system (GIS) involvement in Henoch-Schönlein purpura (HSP) when refractory to conventional therapies.
  
  
  METHODS
  We retrospectively reviewed the medical records of HSP patients who had plasma exchange therapy due to massive GIS involvement. We reported age, gender, initial HSP presentation, etiological or triggering factors and disease course. Treatment modalities, side effects and their outcomes were noted.
  
  
  RESULTS
  We reported 7 cases of childhood HSP with severe gastrointestinal involvement refractory to common immunosuppression with systemic steroid and cytotoxic therapy. All patients gave inadequate response to pulse methyl prednisolone or oral prednisolone therapy with ongoing GIS bleeding and severe abdominal pain. Therefore, pulse cyclophosphamide was added to the treatment. Two patients received additional intravenous immunoglobulin (IVIG) therapy. Gastrointestinal manifestations continued and plasma exchange was performed. All patients improved after plasma exchange treatment.
  
  
  CONCLUSIONS
  Treatment of GI involvement in HSP with plasma exchange has been mainly based on case reports. According to our data, we propose that, plasma exchange may be a safe and efficient management choice in paediatric HSP patients with massive GIS involvement that are refractory to other therapies.
authors.affiliation: Department of Paediatric Nephrology and Rheumatology, Ankara Child Health, Haematology, Oncology Education and Research Hospital, Ankara, Turkey.
authors.forename: Ö
authors.initials: Ö
authors.lastname: Başaran
authors.affiliation: Department of Paediatric Nephrology and Rheumatology, Ankara Child Health, Haematology, Oncology Education and Research Hospital, Ankara, Turkey.
authors.forename: N
authors.initials: N
authors.lastname: Cakar
authors.affiliation: Department of Paediatric Nephrology and Rheumatology, Ankara Child Health, Haematology, Oncology Education and Research Hospital, Ankara, Turkey.
authors.forename: N
authors.initials: N
authors.lastname: Uncu
authors.affiliation: Department of Paediatric Nephrology and Rheumatology, Ankara Child Health, Haematology, Oncology Education and Research Hospital, Ankara, Turkey.
authors.forename: B A
authors.initials: BA
authors.lastname: Çelikel
authors.affiliation: Department of Paediatric Haematology, Ankara Child Health, Haematology, Oncology Education and Research Hospital, Ankara, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Kara
authors.affiliation: Department of Paediatric Nephrology and Rheumatology, Ankara Child Health, Haematology, Oncology Education and Research Hospital, Ankara, Turkey.
authors.forename: F S
authors.initials: FS
authors.lastname: Cayci
authors.affiliation: Department of Paediatric Nephrology and Rheumatology, Ankara Child Health, Haematology, Oncology Education and Research Hospital, Ankara, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Taktak
authors.affiliation: Department of Paediatric Nephrology and Rheumatology, Ankara Child Health, Haematology, Oncology Education and Research Hospital, Ankara, Turkey.
authors.forename: G
authors.initials: G
authors.lastname: Gür
mesh_terms: D015746:Abdominal Pain / Q000209:etiology / Q000628:therapy*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D005767:Gastrointestinal Diseases / Q000209:etiology / Q000628:therapy; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D011695:IgA Vasculitis / Q000150:complications / Q000628:therapy*; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007443:Intussusception / Q000209:etiology / Q000628:therapy; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D010951:Plasma Exchange / Q000379:methods*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D008775:Methylprednisolone