The Role of Plasma Exchange in HELLP Syndrome

Abstract

Plasma exchange therapy has been successfully used in selected patients with hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome who have organ failure or refractory to treatment. There is no prospective study regarding plasma exchange and its effect in HELLP syndrome. The aim of this study was to investigate the effects of early postpartum use of plasma exchange in patients with HELLP syndrome on outcomes. The mortality rate and the recovery times were compared in patients with HELLP syndrome treated with plasma exchange and historic control group of patients treated conservatively. During a 3-year period (between April 2000 and December 2003), 29 consecutive patients with HELLP syndrome were treated with single or multiple plasma exchange by using fresh-frozen plasma at post-partum period. The control group consist of 26 patients with HELLP syndrome treated between 1993 and 1999. Maternal mortality rate was 23.1% in the control group; there was no death in plasma exchange group; and the mortality rate was significantly higher in the control group (p=0.006). The length of stay at the intensive care unit was shorter in the plasma exchange group (p<0.0001). Rapid improvement of the platelet, aspartate aminotransferase, alanine aminotransferase, and lactic dehydrogenase levels were observed in the plasma exchange group. This study showed that postpartum early plasma exchange therapy improves treatment outcomes in patients with severe HELLP syndrome.

How I treat thrombocytopenia in pregnancy

“…Several case series suggest that the use of plasma exchange treatment may improve the outcome of both severe HELLP and AFLP. [58][59][60][61][62] …”

The Use of Plasma Exchange in a Very Early-onset and Life Threatening, Hemolysis, Elevated Liver Enzymes, and Low Platelet (HELLP) Syndrome: A Case Report

“…The effectiveness of dexamethasone is not clearly defined [14]. However, some research demonstrated that postpartum plasma exchange therapy improves treatment outcomes in patients with severe HELLP syndrome [11,[15][16][17]. Patients who do not show improvement of platlets and ASAT levels within the first 24 to 48 hours after delivery and patients with renal or neurological involvement may have benefit from plasma-exchange between 24 and 72 hours postpartum as shown by Simetka et al [18].…”

“…If the maternal or fetal conditions deteriorate, delivery should be performed as soon as possible. If the laboratory results or the clinical condition deteriorate, postpartum plasma exchange is reported to improve maternal outcome of severe HELLP syndrome [11].…”

Maternal thrombocytopenia in pregnancy

“…24 The criteria for HELLP syndrome vary among studies, but generally include microangiopathic hemolytic anemia, increased AST more than 40-70 U/ml and thrombocytopenia with platelet counts less than 100, 000/µl. 28 , this approach was demonstrated to induce a rapid remission. For pregnancies fewer than 34 weeks gestation, where there is no maternal and fetal distress, glucocorticoids are recommended to accelerate fetal pulmonary maturity followed by delivery in 48 hours.…”