Retrospective evaluation of plasma exchange which we applied to hellp syndrome patients with intensive care

Introduction: HELLP syndrome is a complication of severe preeclampsia and eclampsia which has a high mortality rate for both the mother and the baby. It is characterized by haemolysis, elevation in the liver enzymes, decrease in the platelet count and should be followed and treated cautiously in the clinic. The etiology and pathogenesis are still not known. The incidence is 0.2-0.8% in all pregnancies, though in severe cases of pregnancy with preeclampsia, the incidence is up to 2-20%. The plasma exchange is an additional therapeutic method in the patients who receive medical treatment. The objective of the study is to evaluate the efficiency of therapeutic plasma exchange in HELLP patients. Material and method: 27 patients diagnosed as HELLP syndrome in their postpartum period that were followed and administered plasma exchange in İnönü University, Faculty of Medicine Intensive Care Unit between January 2011 and December 2015 were evaluated retrospectively in our study. The demographic and gestational properties, GCS, APACHE II and SOFA scores, complications, mortalities, states of consciousness, needs for mechanical ventilation, vital signs, physical examination findings, invasive and noninvasive procedures, blood and blood products, blood gas analysis, complete blood count values, biochemical values and peripheral smear results were recorded and statistically evaluated. Findings: The mean age of our patients was 29.85±5.77. When based on admission values, APACHE II scores was calculated as 18.74±7.46, SOFA score was 8.03±3.63 and GCS was 10.22±5.3. When the haemotological values on admission and before TPE were compared, a statistically significant decrease in Hb, Hct and platelet counts and a increase in WBC, PT, aPTT, INR values were found. When the biochemical values on admission and before TPE were compared, a statistically significant increase was determined in BUN and creatinin values. When the haemotological values on admission and after TPE were compared, a statistically significant increase was determined in platelet values. When we compared the biochemical values on admission and after TPE, a statistically significant increase was determined in AST, ALT, LDH, total bilirubin and conjugated bilirubin. When the haemotological values for patients before and after TPE were compared, a statistically significant increase in Hb, Hct and platelet values and a decrease in WBC, PT, aPTT, INR values were found. When we compared the biochemical values before and after TPE, statistically significant decreases in AST, ALT, LDH, total bilirubin and conjugated bilirubin, BUN, creatinin values were found. In the postpartum period, 12 patients (44.4%) required mechanical ventilation in the intensive care unit. The blood and blood products were transfused in 24 patients (88.9%). The mean duration of the stay in the intensive care unit for patients included in this study was 9.14±8.97 days. When the patients were evaluated in the means of complications; ARF was observed in 11 patients (40.7%), pulmonary edema in 4 patients (14.8%), DIC in 3 patients (11.1%), convulsion in 2 patients (3.4%), intracranial hemorrhage and edema in 1 patient (3.7%) and hepatic necrosis and subcapsular hemorrhage in 1 patient (3.7%). Reoperation was needed in 3 patients (11.1%). Wound infection was not seen in any of our patients. During the follow-up 2 patients (7.4%) died in the intensive care unit. Conclusion: With respect to diagnosis and treatment, HELLP syndrome is a disease that requires a multidisciplinary approach. Plasma exchange therapy is highly required for patients with HELLP syndrome; in that way the evolution of complications decreases in particular and the duration of stay in the intensive care unit and the hospital shortens with plasma exchange. For that reason, the patients should be followed and treated in the comprehensive intensive care units in which therapeutic plasma exchange can be administered in the guidance of related internal medicine and surgical specialists. When all these are taken into consideration, the therapeutic plasma exchange is an essential therapeutic method for this patient group.