The Use of Plasma Exchange in a Very Early-onset and Life Threatening, Hemolysis, Elevated Liver Enzymes, and Low Platelet (HELLP) Syndrome : A Case Report
HELLP syndrome is a life threatening pregnancy and early postpartum complication. Very early presentation (before the 21st pregnancy week) is rare and represents an extremely difficult situation for patients and physicians. Supportive therapy (magnesium sulfate, antihypertensive drugs and corticosteroids) may be useful to prolong pregnancy; till now the removing of placenta is the only effective therapeutic option. Plasmapheresis may represent a new and efficacious therapeutic option.
Case description: The article reports on a case of very-early onset HELLP Syndrome at the 18th (17+5) week of gestation. It was a challenging clinical and therapeutic case. Since the fetus did not show any signs of growth retardation or pathological Doppler findings, indicating a good fetal prognosis, we used plasmapheresis as an ultima ratio to prolong pregnancy. With plasmapheresis, the pregnancy was prolonged for 20 days. Unfortunately the deterioration of the clinical situation required delivery in the 21st (20+4) gestational week.
Conclusion: Plasmapheresis allows prolongation of pregnancy with early onset, life threatening HELLPSyndrome.