plasmapheresis hellp

HELLP-syndrome is one of the most severe variants of liver failure in pregnancy. The incidence among pregnant patients is 0.5-0.9%, and in presence of severe preeclampsia and eclampsy the incidence is 10-20%. Pathogenesis of HELLP-syndrome has common features with pathogenesis of preeclampsia, DIC-syndrome and fatty hepatosis of pregnant, this is confirmed by pathomorphological changes of liver in women with HELLP-syndrome. Efficacy of conservative therapy (corticosteroids, magnesium sulphate, hypotensive therapy, hepatoprotectors) and disintoxication methods (plasmapheresis, MARS-therapy) is not evident...

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Thrombotic thrombocytopenic purpura (TTP), which is typically characterized by fever and central nervous system manifestations and hemolytic uremic syndrome (HUS), in which renal failure is a prominent feature are the most common thrombotic microangiopathies (TMAs). TTP is usually associated with a severe deficiency of ADAMTS13 [a metalloproteinase involved in the degradation of von Willebrand factor (vWF) multimers], causing excessive accumulation of ultra-large vWF multimers and platelet aggregation with organ failure...

Acute renal failure is a serious complication of pregnancy associated with a high rate of morbidity and mortality; the incidence is currently 1 per 10,000 pregnancies. The most common causes are gestational hypertension, bleeding, sepsis, and intrinsic renal disease. Other less common pregnancy-related syndromes, such as HELLP syndrome or thrombotic microangiopathy, may also lead to kidney failure. Hemolytic uremic syndrome and thrombotic thrombocytopenic purpura are forms of thrombotic microangiopathy and although neither is specific to pregnancy, the incidence of these entities rises during gestation...

Thrombotic thrombocytopenic purpura (TTP) represents a rare complication mainly in the second trimester and can, in its early stage, mimic HELLP syndrome. At 38 weeks of gestation, a 40-year-old primigravida with elevated blood pressure, thrombocytopenia and elevated liver enzymes was diagnosed with HELLP syndrome. Despite a Ceasarean section her laboratory parameters remained pathological with severe thrombocytopenia and hemolysis. In addition, the patient developed neurological comatose-like symptoms. The diagnosis of TTP was made after further tests revealed fragmented red cells in the blood, autoantibodies against ADAMTS13 and a nearly total loss of ADAMST13 plasma activity...

Authors present the first Hungarian case of a young pregnant woman with the association of antiphospholipid syndrome (APS) and hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. After the onset of severe preeclampsia, the pregnancy was terminated but the patient's condition continued to worsen. New symptoms of APS, including deep vein thrombosis and ischemic nervus opticus lesion, developed in the patient followed by the onset of acute respiratory distress syndrome, which required respiratory therapy...

Hemolytic uremic syndrome (HUS) includes a heterogeneous group of hemolytic disorders. Among the identified causes of HUS are infections, particularly infections with Shiga toxin-producing ESCHERICHIA COLI (STEC), complement disorders, and disorders interfering with the degradation of von Willebrand factor (VWF). Other causes for atypical HUS include the cobalamin metabolism; pregnancy/hemolysis, elevated liver enzymes, and low platelets syndrome (HELLP); drugs; and other disorders (e.g., systemic diseases appearing as HUS, such as systemic lupus erythematosus and rejection after transplantation)...

BACKGROUND: Plasma therapies are being applied to thombotic syndromes, but there are limited controlled studies. OBJECTIVE: To review the evidence and the current practices for plasma therapies in thrombotic syndromes. METHODS: Expert-enhanced evidence-based analysis. Evidence obtained as of Dec 31, 2002 using PubMed electronic reference library and expert-obtained library for a total of > 3,000 references obtained using the terms plasma therapy or plasma exchange or plasmapheresis or plasmafiltration or sorbents each combined with the words thrombotic syndrome or sepsis or septic shock...

Spontaneous hepatic haemorrhage in pregnancy (SHHP) is a rare event (1 woman out of 15,000). It is generally considered as an advanced state of the microangiopathic hemolytic anemia (HELLP, Hemolysis, Elevated Liver enzyme levels, Low Platelet count). Furthermore, the HELLP is considered as a different form of preeclampsia. The patient, a 33-year-old-woman at 30 weeks' gestation, was admitted to hospital for preeclampsia, underwent an emergency Stark caesarean section with the extraction of an alive foetus and evidence of massive intraperitonal haemorrhage from a large hepatic haematoma...

We analyzed the clinical characteristics, complications, severity, and maternal and fetal survival of patients suffering from HELLP syndrome (Hemolysis, Elevated Liver enzymes level, Low Platelet count) requiring admission to the intensive care unit in four hospitals from Buenos Aires area, Argentina. Data was revised in the charts from March 1997 to March 2003 and 62 patients were included in the study. During the second half of pregnancy or immediate puerperal period, diagnostic criteria were defined on the basis of preeclampsia and the following laboratory abnormalities: platelet count nadir <150,000/mm3, serum hepatic aminotransferases >70 UI/l, and serum lactic dehydrogenase >600 UI/l, total bilirubin >1...

Thrombotic microangiopathies are disorders that arise due to a diffuse endothelial damage. They predominantly manifest either as thrombotic trombocytopenic purpura (TTP) or hemolytic uremic syndrome (HUS). When they arise as a complication of pregnancy and associated disorders they are associated with a high mortality and morbidity.

OBJECTIVE: To determine whether the measurement of the Von Willebrand factor cleaving protease ADAMTS-13, such as is carried out at the University Medical Centre of Utrecht, The Netherlands, contributes towards the diagnosis and treatment of patients with thrombotic thrombocytopenic purpura (TTP). DESIGN: Descriptive. METHOD: In a group of 98 patients from 21 hospitals, with a Coombs-negative haemolytic anaemia and thrombocytopenia, the ADAMTS-13 activity was measured...

Case report was presented of a 22 year old pregnant patient with diagnosed intrauterine fetal death, who developed HELLP syndrome and acute renal failure. Immediate hemodialysis treatment was initiated that permitted management of pulmonary edema; subsequent plasmapheresis eliminated not only elevated bilirubin and toxins liberated to circulation from the dead intrauterine fetus but also allowed for patient recovery. The HELLP Syndrome requires careful obstetric supervision and if possible treatment in the Intensive Care Unit...

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Severe preeclampsia and HELLP syndrome are still one of the leading causes of maternal and perinatal morbidity and mortality. The current definitions of the diseases should be considered before treatment. The timely allocation to a perinatal center and an intensive monitoring of mother and child after admission are mandatory for successful management of these patients. The aim of therapy is immediate stabilization of the mother's condition by means of anticonvulsive prophylaxis with intravenous magnesium sulphate, well-controlled reduction of blood pressure by the administration of urapidil or nifedipine, controlled volume expansion and an adequate treatment of coagulation disorders by giving fresh frozen plasma (not heparin)...

No abstract text is available yet for this article.

Authors report the case of a pregnant woman with antiphospholipid syndrome associated with HELLP syndrome. Pregnancy was terminated because of severe preeclampsia. However the patient's condition worsened. New symptoms of antiphospholipid syndrome developed (deep vein thrombosis, ischaemic optic lesion) and ARDS, therefore respiratory therapy was introduced. Plasmaphereses were performed concomitantly with high-dose intravenous immunoglobulin, glucocorticoid, cyclophosphamide and anticoagulant therapy. She responded to the therapy well, and eventually recovered completely...

BACKGROUND: Thrombotic microangiopathies are diseases rarely associated with pregnancy. The pathogenesis might be related to severe preeclampsia and HELLP syndrome. CASE REPORT: In May 2000, we saw a 26-year-old primigravida in the 39th gestational week with worsening anemia, thrombocytopenia, and increasing liver enzymes. The diagnosis of HELLP syndrome was made and delivery initiated. Postpartum liver function stabilized, but anemia, thrombocytopenia, and preexisting hypertension worsened...

Renal failure occurring in pregnancy or post partum is an unusual but well-described complication. Acute renal failure seems to be associated more often with HELLP syndrome rather than with pre-eclampsia or chronic hypertension. Probable overlapping of HELLP and hemolytic uremic syndrome in pregnancy or postpartum should be taken into consideration when treating pregnant women who show signs of proteinuria, hypertension, hematuria, increase of reticulocytes, decrease of haptoglobin with thrombocytopenia and microangiopathic hemolytic anemia...

We reviewed 24 episodes of thrombotic microangiopathy (TMA) representing 22 patients from July 1989 to July 1998. Nine cases presented with a community acquired (CA group) thrombotic thrombocytopenic purpura or hemolytic uremic syndrome (TTP/HUS), 3 cases were related to pregnancy (P group), 10 cases were compatible with TMA after bone marrow transplantation or chemotherapy (BMT/C group), and 2 cases had a background of scleroderma (SC group). Twenty episodes were treated exclusively with therapeutic plasma exchange (TPE) using fresh frozen plasma (FFP) replacement...