From the Guidelines
Henoch-Schönlein Purpura (HSP) is not an indication for therapeutic plasma exchange.
Indications for Plasma Exchange
- Systemic Lupus Erythematosus (SLE): Plasma exchange may be considered in severe cases of SLE, particularly those with renal involvement or other organ-threatening disease 1.
- Anti-Glomerular Basement Membrane (anti-GBM) disease: Plasma exchange is recommended for patients with anti-GBM disease, especially those with severe renal disease or pulmonary hemorrhage 1.
- Pauci-Immune Anti-Neutrophil Cytoplasmic Antibody (ANCA)-Associated Vasculitis: Plasma exchange may be considered for patients with ANCA-associated vasculitis, particularly those with severe renal disease or pulmonary hemorrhage 1.
- Thrombotic Thrombocytopenic Purpura (TTP): Plasma exchange is a standard treatment for TTP, and is often used in conjunction with other therapies such as glucocorticoids and rituximab.
Evidence for HSP
There is limited evidence to support the use of plasma exchange in HSP, and it is not typically recommended as a treatment for this condition. The focus of treatment for HSP is usually on supportive care, such as rest, hydration, and pain management, as well as glucocorticoids in severe cases.
Key Points
- Plasma exchange is a therapeutic option for certain conditions, including SLE, anti-GBM disease, ANCA-associated vasculitis, and TTP.
- HSP is not typically an indication for plasma exchange, and treatment usually focuses on supportive care and glucocorticoids in severe cases.
- The decision to use plasma exchange should be individualized and based on the specific clinical context, including the severity of disease and the presence of organ-threatening complications.
From the Research
Conditions and Therapeutic Plasma Exchange
The following conditions are indications for therapeutic plasma exchange:
- Systemic Lupus Erythematosus (SLE) 2, 3, 4, 5
- anti-Glomerular Basement Membrane (anti-GBM) disease 6
- Pauci-Immune Anti-Neutrophil Cytoplasmic Antibody (ANCA)-Associated Vasculitis 6
- Thrombotic Thrombocytopenic Purpura (TTP) 2, 6, 5
Conditions Not Typically Indicated for Therapeutic Plasma Exchange
- Henoch-Schönlein Purpura (HSP) - there is no evidence to suggest that HSP is an indication for therapeutic plasma exchange in the provided studies 2, 3, 4, 6, 5 Note that the provided studies do not directly address the use of therapeutic plasma exchange in HSP, but they do discuss its use in other conditions.
Key Findings
- Therapeutic plasma exchange can be beneficial in selected patients with SLE, particularly those with acute life-threatening manifestations or severe therapy-resistant manifestations 2, 3, 4, 5
- The efficacy of therapeutic plasma exchange has been established for certain rare diseases, including some forms of Goodpasture's syndrome and thrombotic thrombocytopenic purpura/haemolytic uraemic syndrome 6