All patients were refractory to at least two forms of therapy. Splenectomy had been performed in 15. A median of 8 procedures were performed over a 2-3 week period processing 500 mls of plasma. Lower preference alternatives included Rh immune globulin, ascorbic acid, colchicine, cyclosporine, and interferon. It should be noted that these recommendations were published in 1996, when there was less experience using intravenous Rh immune globulin.
Symptoms are less common if the patient is receiving prednisone.
The possibility of severe reactions exists, including anaphylactoid manifestations, vasculitis, thrombosis, or exacerbation of underlying disease. Most of the serious reactions were reported in the older literature. These drugs inhibit the metabolism of bradykinin, which is formed during column perfusion. Appropriate patient selection is essential. Snyder HW, Cochran SK, et al.