: Despite observed and theoretical effectiveness and safety in immune thrombocytopenia (ITP), partial splenic angioembolization has not yet been included in clinical practice recommendations. At present, this is the first and only recorded case of partial splenic angioembolization done for chronic ITP in our institution. This case report will add to the growing body of evidence of partial splenic angioembolization as a viable and attractive alternative in treating refractory ITP among patients who refuse or are otherwise unfit for surgery. : We present a 61-year-old female, known chronic ITP unresponsive to steroids, vincristine, rituximab, mycofenolate mofetil, avatrombopag and azathioprine. She refused splenectomy and was offered partial splenic angioembolization. She achieved a durable response at post-procedure days 67, 82, and 130 with platelet count at 50 x 109/L, 85 x 109/L, and 72 x 109/L, respectively, despite continued slow tapering of prednisone and discontinuation of TPO-RA and other immunosuppressive agents. Immune thrombocytopenia (ITP) results from decreased platelet function and increased platelet destruction. About 10% of ITP becomes refractory to treatment within a year. Even among hematologists, the management of refractory chronic ITP remains to be challenging. Splenic artery angioembolization has traditionally been used as an optimization prior to splenectomy of massively enlarged spleens. Its effectiveness in treating ITP remains uncertain. However, current practice endorses it as a rescue therapy in patients deemed unfit for splenectomy.
Human ; Female ; Middle Aged: 45-64 yrs old

Background and Objective: Convalescent plasma therapy (CPT) may reduce the risk of disease progression among patients with COVID-19. This study was undertaken to evaluate the efficacy and safety of CPT in preventing ICU admission among hospitalized COVID-19 patients. Methods: In this open-label randomized controlled trial, we randomly assigned hospitalized adult patients with COVID-19 in a 1:1 ratio to receive convalescent plasma as an adjunct to standard of care or standard of care alone. The primary endpoint was ICU admission within first 28 days of enrolment. Primary safety endpoints include rapid deterioration of respiratory or clinical status within four hours of convalescent plasma transfusion and cumulative incidence of serious adverse events during the study period including transfusion-related acute lung injury (TRALI), transfusion-associated circulatory overload (TACO), severe allergic reactions, and transfusion-related infections. Results: A total of 22 patients were assigned to receive convalescent plasma as an adjunct to standard of care and 22 to receive standard of care alone. The median time from onset of COVID-19 symptoms to study enrolment was eight days (IQR, 4 to 10). Two patients (9.1%) in the CPT group and one patient (4.5%) in the control group were admitted to the ICU. The primary outcome measure, ICU admission, was not different between the two groups (q-value >0.9). No patient who received convalescent plasma had rapid deterioration of respiratory/clinical status within four hours of transfusion and none developed TRALI, TACO, anaphylaxis, severe allergic reactions, or transfusion-related infections. There was also no significant difference in the secondary outcomes of 28-day mortality (two patients in the CPT group and none in the control group, q-value >0.90), dialysis-free days, vasopressor-free days, and ICU-free days. Conclusions Among hospitalized COVID-19 patients, no significant differences were observed in the need for ICU admission between patients given CPT as adjunct to standard of care and those who received standard of care alone. Interpretation is limited by early termination of the trial which may have been underpowered to detect a clinically important difference.
COVID-19 ; COVID-19 Serotherapy