en Pediatric Hematology & Oncology Pediatric Hematology & Oncology گزارش مورد Case report Treatment of severe Immune Thrombocytopenic purpura (ITP) accompanied by life-threatening bleeding events is challenging and a combination of treatment measures should be undertaken to rapidly increase the platelet count. Herein, we report a case of severe ITP in a seven-year-old boy who suffered from massive bleeding which was totally unresponsive to conventional therapeutic interventions. Since the patient was still symptomatic with severe thrombocytopenia after splenectomy, the patient underwent plasma exchange (PE) which was successful. To best of our knowledge this is the first case of severe ITP in children managed with plasma exchange due to unresponsiveness to standard treatments and splenectomy. Keywords: Immune mediated thrombocytopenia, Plasma exchange, Children, refractory Immune mediated thrombocytopenia, Plasma exchange, Children, refractory 163 166 http://ijbc.ir/browse.php?a_code=A-10-9-46&slc_lang=en&sid=1 Eshghi P 10031947532846003017 10031947532846003017 No Malek F 10031947532846003018 10031947532846003018 Yes Madani F 10031947532846003019 10031947532846003019 No Esfahani H 10031947532846003020 10031947532846003020 No