Plasma exchange for preeclampsia: III. Immediate peripartal utilization for selected patients with hellp syndrome

✍ Scribed by James N. Martin Jr.; Kenneth G. Perry Jr.; William E. Roberts; Joe C. Files; Patricia F. Norman; John C. Morrison; Pamela G. Blake

• Publisher: John Wiley and Sons
• Year: 1994
• Tongue: English
• Weight: 466 KB
• Volume: 9
• Category: Article
• ISSN: 0733-2459
• DOI: 10.1002/jca.2920090303

✦ Synopsis

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 preeclampsideclampsia and hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. STUDY DESIGN: Two gravidas with complicated severe preeclampsialecIampsiaiHELLP syndrome were treated emergentiy in the immediate peripartal period with singlevolume plasma exchange and fresh frozen plasma fluid replacement using the IBM 2997 Cell Separator. RESULTS: Despite niultiplc platelet unit infusions, one primigravida in active labor at 5 cm cervical dilatation and 39 weeks' gestation remained at a platelet count of 14,OOOi~L and began to ooze from her gums. A second primigravida remained obtunded, oliguric, and thrombocytopcnic 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. G 1 9 ~4 ~i ~e y -~i \ s .