The role of therapeutic plasma exchange in the first-line treatment of hellp syndrome

ABSTRACT Aim: HELLP syndrome, which can affect multiple organ systems and cause maternal and fetal mortality, is a serious complication of pregnancy characterized by microangiopathic hemolytic anemia, elevation of liver enzymes, and thrombocytopenia. Delivering the infant usually suffices for the treatment of this syndrome. In cases with Class I HELLP syndrome, however, the clinical picture may rapidly deteriorate despite delivery. In this paper we presented the outcomes with the use of therapeutic plasma exchange (TPE) in cases with class I HELLP syndrome. Method: This study included 21 patients diagnosed with the HELLP syndrome at Inonu University Faculty of Medicine, Department of Hematology between 2011 and 2014. All patients met the Mississippi criteria for class I HELLP syndrome. All patients had metabolic derangement and impaired consciousness despite completion of delivery. All patients underwent therapeutic plasma exchange for three sessions each with a 1:1 volume. Hemogram and biochemical parameters of the patients were evaluated before and after the procedure. Results: The mean age of the study participants was 31+4.9(23-38) years. The mean hemoglobin level before and after therapeutic plasma exchange of the patients were 8.8+1.8 and 10.1+2.5 (p:0.7), respectively. The corresponding values were 32.100±10.100 and 174.200 ± 110.200 (p:0.001), respectively for the thrombocyte count (µL); 16.500 ± 6.500 and 12.700 ± 5.070 (p:0.015), respectively for the leucocyte count (µ); 1721.1±1053.8 and 361.3±217.07 (p:0.0001), respectively for LDH (U/L); 709.8±136.2and 68.7±21.5 (p:0.001), respectively for AST (U/L); 350.6±64.2and 47.2±30.6 (p:0.001), respectively for ALT (U/L); 7.5±5.7and 2.3±1.1 (p: 0.03), respectively for total bilirubin(mg/dL); and 2.68±1.51and 1.67±1.06 (p:0.17), respectively for creatinine (mg/dL). According to these results, there was a statistically significant decrease in leucocyte count, bilirubin, LDH, AST, and ALT levels whereas a significant increase in thrombocyte count was observed. Hemoglobin levels were increased, although this increase was not statistically significant. These parameters returned to normal levels after therapeutic plasma exchange. BUN and creatinine levels improved, albeit non-significantly. Discussion: HELLP syndrome is primarily treated with the delivery of infant, however some cases may show disease progression despite completion of delivery. As a potential cause of both maternal and fetal mortality, HELLP syndrome condition should be aggressively treated. Therapeutic plasma exchange is one of the available treatment options. In our study, therapeutic plasma exchange was found to be an effective and life-saving treatment option in Class I HELLP syndrome occurring in the early postpartum period. Key words: HELLP Syndrome, Therapeutic Plasma Exchange