Plasma       

therapy in HELL  

LP synddrome

Apollo Medicine 2012 SeptemberVolume 9, Number 3; p. 276 Journal Scan

Plasma therapy in HELLP syndrome

Director R.N. Makroo

Plasma exchange therapy in HELLP syndrome: a single-center experience. Ziya Bayraktaroglu, Fikret Demiric, ÖzcanBalat, Irfan Kutlar, Vahap Okan, Gürol Ugur. Turk J Gastroenterol. 2006;17(2): 99e102.

Abstract:Background: The aim of this study was to investigate the effectiveness of plasma exchange therapy in patients with variousforms of hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome.Methods:During a3-year period, 13patientswithHELLPsyndromewere treatedwith oneor two sessionsof plasmaexchangeafter delivery. Diagnosis of hemolysis, elevated liver enzymes, and low platelets syndrome was made according to Sibai’scriteria, and the severity of illness was categorized according to platelet counts. Among patients, nine were in class-1 andthe remaining four were in class-2. Patients with very high levels of aspartate aminotransferase (AST) (>2000 U/L) and lactatedehydrogenase (LDH) (>3000 U/L) were defined as fulminant type (2 cases).Results: Rapid improvement in platelet counts was observed after treatment with plasma exchange. All patients survivedexcept the two fulminant hemolysis, elevated liver enzymes, and low platelets syndrome cases.Conclusions: In our study, plasma exchange therapy was effective in patients with severe hemolysis, elevated liverenzymes, and low platelets syndrome, but fulminant cases did not appear to respond to this therapy.

COMMENTS

‘HELLP syndrome’ (hemolysis, elevated liver enzymes, and low platelets) is a potentially lethal complication of severepreeclampsia. Therapeutic plasma exchange has emerged as an important treatment modality especially in patients with progres-sive elevation of bilirubin or creatinine for over 72 h.

The authors have demonstrated with success, a good response to 1e2 sessions of plasma exchanges in most of their casesexcept two, who succumbed to multi organ failure. A fairly good follow-up period of 3 months after discharge further substantiatestheir results. They have also demonstrated that the procedure is not only effective but also safe, with only minimal adverse reac-tions in 4 patients, which were not severe enough to interrupt the procedures.

The Indraprastha Apollo Hospitals, being an advanced tertiary care and referral center caters to a large number of patientsfrom all disciplines of medicine. With a busy plasma exchange programme, we successfully treat patients with renal, neurologicaland hematological disorders among others. We have encountered 5 cases of HELLP syndrome in our experience so far. Thesehave been treated with 1e5 sittings of 1e1.5 volume exchanges each. Three patients were successfully treated and discharged instable condition, while 2 succumbed to their illness.

Departments of Pediatrics and Transfusion Medicine, Molecular Biology and Transplant Immunology, India.email: makroo@apollohospitals.comReceived: 6.6.2012; Accepted: 29.6.2012; Available online: 7.7.2012http://dx.doi.org/10.1016/j.apme.2012.06.005

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