Plasma exchange for preeclampsia: I. postpartum use for persistently sever preeclampsia-eclampsia with HELLP syndrome

Article Abstract:

Preeclampsia is a syndrome characterized by hypertension, or high blood pressure, protein in the urine, and edema, or the movement of water into the body tissues. In the extreme case of eclampsia, convulsions and coma may result. These syndromes may occur with or without HELLP syndrome, which stands for hemolysis, elevated liver enzymes, and low platelet count (destruction of blood cells, abnormal liver function and diminished clotting factor). In pregnant women, preeclampsia generally resolves spontaneously after delivery. However, in some cases, the condition persists, and may require aggressive intervention. Seven case histories of women with preeclampsia (six) or eclampsia (one) associated with HELLP syndrome, which persisted for more than 72 hours after delivery, indicate the clinical value of plasma exchange. Using an IBM model 2997 Cell Separator, the patient's plasma could be exchanged for fresh frozen plasma while retaining the patient's blood cells. Although each case was unique and required a unique application of the technique, all benefitted, and no serious reactions occurred. It is not clear whether the fresh frozen plasma is providing a factor which is missing from the patient's blood, or whether some toxic substance is being eliminated from the patient's blood by the procedure. Nonetheless, plasma exchange seems to offer great promise for the treatment of preeclampsia-eclampsia with HELLP. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Case studies

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The natural history of HELLP syndrome: patterns of disease progression and regression

Article Abstract:

Preeclampsia is a condition that can begin around the 20th week of pregnancy and is characterized high blood pressure, edema (accumulation of fluid), and excess protein in the urine. It is estimated that 4 to 12 percent of the patients with preeclampsia develop a related condition called the HELLP syndrome. This syndrome causes hemolysis (destruction of red blood cells), high levels of lactate dehydrogenase in the blood (an indication liver malfunction), and low levels of blood cells called platelets. The clinical symptoms of the HELLP syndrome include abdominal pain, tenderness in the region of the liver, and nausea. In severe cases, HELLP can cause blood clots to form within the blood vessels and it can result in death. It is not uncommon for milder forms of this syndrome to be misdiagnosed as some other condition. This article describes the clinical features of the HELLP syndrome in 158 pregnant women. Between the time of hospital admission to the time of delivery (which ranged from 1 to 60 hours), maternal blood levels of liver enzymes increased and the number of platelets in the blood decreased. The HELLP syndrome was most severe between 24 and 48 hours after delivery, when blood platelet levels were lowest and lactate dehydrogenase levels were highest. Within four to six days following delivery the levels of lactate dehydrogenase and blood platelets returned to normal. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Physiological aspects, Development and progression, Pregnancy, Complications of, Pregnancy complications, Blood chemical analysis, blood

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Postpartum plasma exchange for atypical preeclampsia-eclampsia as HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome

Article Abstract:

Postpartum plasma exchange appears to be helpful in patients with atypical HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome but only when there is no major deterioration of organ systems. HELLP is a rare complication of preeclampsia in pregnancy. Atypical HELLP occurs when HELLP fails to resolve within a few days after delivery or when it develops after delivery. Between 1984 and 1993, 18 patients with recalcitrant HELLP syndrome were given one or more plasma exchange transfusions when they failed to respond to other therapy. Nine women had multiple complications: infections, immune system or coagulation abnormalities, or damage to the central nervous system, kidneys, heart, or lungs. The nine women who were free of organ damage all responded rapidly to one or two transfusions. By contrast, four women in the group with additional complications failed to respond to transfusion and two women died.

Care and treatment, Evaluation

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