Proposed as a treatment strategy in patients with a recent history of HIT who require cardiopulmonary bypass surgery, and in patients with active HIT who are not responding to standard therapy. The evidence to date consists of retrospective case reports.[66]Karafin MS, Sachais BS, Connelly-Smith L, et al. NHLBI state of the science symposium in therapeutic apheresis: knowledge gaps and research opportunities in the area of hematology-oncology. J Clin Apher. 2016 Feb;31(1):38-47.
http://www.ncbi.nlm.nih.gov/pubmed/25940408?tool=bestpractice.com
[67]Onuoha C, Barton KD, Wong ECC, et al. Therapeutic plasma exchange and intravenous immune globulin in the treatment of heparin-induced thrombocytopenia: a systematic review. Transfusion. 2020 Nov;60(11):2714-36.
http://www.ncbi.nlm.nih.gov/pubmed/32812222?tool=bestpractice.com
Intravenous immune globulin
Case reports suggest that high dose intravenous immune globulin can be considered for severe HIT that is refractory to standard treatments.[67]Onuoha C, Barton KD, Wong ECC, et al. Therapeutic plasma exchange and intravenous immune globulin in the treatment of heparin-induced thrombocytopenia: a systematic review. Transfusion. 2020 Nov;60(11):2714-36.
http://www.ncbi.nlm.nih.gov/pubmed/32812222?tool=bestpractice.com
[68]Padmanabhan A, Jones CG, Pechauer SM, et al. IVIg for treatment of severe refractory heparin-induced thrombocytopenia. Chest. 2017 Sep;152(3):478-85.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5812774
http://www.ncbi.nlm.nih.gov/pubmed/28427966?tool=bestpractice.com