POSTPARTUM PLASMA-EXCHANGE FOR ATYPICAL PREECLAMPSIA-ECLAMPSIA AS HELLP (HEMOLYSIS, ELEVATED LIVER-ENZYMES, AND LOW PLATELETS) SYNDROME

OBJECTIVE: Our purpose was to investigate the postpartum use of plasma exchange in patients considered to have atypical preeclampsia-eclamps ia manifested as persistent HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome with or without evidence of other organ in jury. STUDY DESIGN: During a 10-year period, 18 patients with HELLP sy ndrome were treated post partum with single or multiple plasma exchang e with fresh-frozen plasma. Each patient was entered into the clinical trial either because of persistent evidence of atypical preeclampsia- eclampsia as HELLP syndrome >72 hours after delivery (group 1) or with evidence of worsening HELLP syndrome at any time post partum in assoc iation with single- or multiple-organ injury (group 2). All procedures were performed with the IBM 2997 Cell Separator (IBM, Cobe Laboratori es, Inc., Lakewood, Colo.) system. Maternal and perinatal outcomes wer e the main outcomes studied. RESULTS: In the absence of other disease conditions, the 9 patients in group 1 with persistent postpartum HELLP syndrome complicated only by severe clinical expressions of preeclamp sia-eclampsia responded rapidly to one or two plasma exchange procedur es with few complications and no maternal deaths. In contrast, in the 9 patients of group 2 with HELLP syndrome presentations complicated by other organ disease, the response to plasma exchange was variable and there were two deaths in this group. CONCLUSION: The current series o f patients details the successful postpartum application of plasma exc hange therapy for unremitting HELLP syndrome but reveals that a unifor mly positive response to this therapy will not always be observed when there is additional single or multiple organ injury.