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Plasma exchange for preeclampsia: III. Immediate peripartal utilization for selected patients with hellp syndrome
Author(s) -
Martin James N.,
Perry Kenneth G.,
Roberts William E.,
Files Joe C.,
Norman Patricia F.,
Morrison John C.,
Blake Pamela G.
Publication year - 1994
Publication title -
journal of clinical apheresis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.697
H-Index - 46
eISSN - 1098-1101
pISSN - 0733-2459
DOI - 10.1002/jca.2920090303
Subject(s) - hellp syndrome , medicine , fresh frozen plasma , preeclampsia , hemolysis , obstetrics , eclampsia , pregnancy , surgery , platelet , genetics , biology
OBJECTIVE: To explore the potential efficacy of plasma exchange as an ancillary interventive therapeutic tool immediately before or after delivery in the patient with severe preeclampsia/eclampsia and hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. STUDY DESIGN: Two gravidas with complicated severe preeclampsia/eclampsia/HELLP syndrome were treated emergently in the immediate peripartal period with single‐volume plasma exchange and fresh frozen plasma fluid replacement using the IBM 2997 Cell Separator. RESULTS: Despite multiple platelet unit infusions, one primigravida in active labor at 5 cm cervical dilatation and 39 weeks' gestation remained at a platelet count of 14,000/μL and began to ooze from her gums. A second primigravida remained obtunded, oliguric, and thrombocytopenic with epistaxis and hematuria following cesarean delivery and platelet transfusions. A single expedited 3‐liter plasma exchange procedure reversed the rapidly deteriorating clinical situation for each patient and accelerated recovery from HELLP syndrome. Both patients and progeny suffered no permanent sequelae. CONCLUSION: Based on our experience, we believe that the therapeutic modality of plasma exchange with fresh frozen plasma can be employed effectively for the pregnant patient with severe atypical HELLP syndrome that progressively worsens during labor or the early puerperium despite the use of conventional transfusion therapy.