EFFECT OF THE HELLP-SYNDROME ON MATERNAL IMMUNE FUNCTION

The HELLP syndrome occurs in less than 1 % of gravidas and is characte rized by hemolysis, elevated liver enzymes and low platelet count. The status of immune function in these high-risk patients is not known bu t may be of great importance in better understanding the basis, if any , of immune dysfunction in pregnancy-associated hypertensive disorders and from the potential compounding effect of infection upon an alread y debilitated patient. We assessed maternal immune status in patients with the HELLP syndrome using conventional in vitro techniques. The re sults of these studies clearly show a depression of both T and B cell potential and impaired monocyte handling of intracellular pathogens (u p to 33 %, 11 % and 17 % of control values, respectively). The onset o f this immunosuppression occurred before the clinical diagnosis of HEL LP syndrome was made and persisted for at least 14 days after clinical resolution. Results of cell admixture studies suggest that these effe cts are mediated by accessory cells or their products and do not repre sent true lymphocyte dysfunction. The risk of opportunistic infections may therefore be increased in the patient with the HELLP syndrome bec ause of this generalized immunosuppression and profound decrease in mo nocyte phagocytic and bactericidal activity.