AN ASSOCIATION BETWEEN REFRACTORY HELLP-SYNDROME AND ANTIPHOSPHOLIPIDANTIBODIES DURING PREGNANCY - A REPORT OF 2 CASES

The HELLP syndrome (hemolysis, elevated liver enzymes and low platelet s) is a thrombotic microangiopathic vasculopathy that presents in preg nancy. HELLP syndrome usually resolves with delivery of the fetus with out sequelae and is often managed successfully with conservative care. To our knowledge, there has been no prior report of an association be tween HELLP syndrome and elevated titers of antiphospholipid antibodie s (aPL). We describe 2 patients who each presented with HELLP syndrome that was refractory despite delivery of the fetus, corticosteroids, a nd anticoagulation. Both patients had elevated levels of anticardiolip in antibodies. Examination of skin and placental pathology revealed di ffuse deposition of fibrin with small vessel thrombi, without evidence of vasculitis. Coincident with plasmapheresis, HELLP resolved in both patients. We conclude that there may be an association between the pr esence of aPL and a protracted HELLP syndrome in pregnancy; this may b e a new manifestation of the antiphospholipid syndrome. Plasmapheresis appears to benefit these patients. Further investigation into this as sociation is warranted.