PLASMA-EXCHANGE FOR PREECLAMPSIA .3. IMMEDIATE PERIPARTAL UTILIZATIONFOR SELECTED PATIENTS WITH HELLP-SYNDROME

OBJECTIVE: To explore the potential efficacy of plasma exchange as an ancillary interventive therapeutic tool immediately before or after de livery in the patient with severe preeclampsia/eclampsia and hemolysis , elevated liver enzymes, and low platelet count (HELLP) syndrome. STU DY DESIGN: Two gravidas with complicated severe preeclampsia/eclampsia /HELLP syndrome were treated emergently in the immediate peripartal pe riod with single-volume plasma exchange and fresh frozen plasma fluid replacement using the IBM 2997 Cell Separator. RESULTS: Despite multip le platelet unit infusions, one primigravida in active labor at 5 cm c ervical dilatation and 39 weeks' gestation remained at a platelet coun t of 14,000/muL 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 sin gle expedited 3-liter plasma exchange procedure reversed the rapidly d eteriorating clinical situation for each patient and accelerated recov ery from HELLP syndrome. Both patients and progeny suffered no permane nt sequelae. CONCLUSION: Based on our experience, we believe that the therapeutic modality of plasma exchange with fresh frozen plasma can b e employed effectively for the pregnant patient with severe atypical H ELLP syndrome that progressively worsens during labor or the early pue rperium despite the use of conventional transfusion therapy. (C) 1994 Wiley-Liss, Inc.