title: Plasma exchange for preeclampsia: III. Immediate peripartal utilization for selected patients with HELLP syndrome.
abstract: OBJECTIVE
  To explore the potential efficacy of plasma exchange as an ancillary interventive therapeutic tool immediately before or after delivery in the patient with severe preeclampsia/eclampsia and hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome.
  
  
  METHODS
  Two gravidas with complicated severe preeclampsia/eclampsia/HELLP syndrome were treated emergently in the immediate peripartal period with single-volume plasma exchange and fresh frozen plasma fluid replacement using the IBM 2997 Cell Separator.
  
  
  RESULTS
  Despite multiple platelet unit infusions, one primigravida in active labor at 5 cm cervical dilation and 39 weeks' gestation remained at a platelet count of 14,000/microL and began to ooze from her guns. A second primigravida remained obtunded, oliguric, and thrombocytopenic with epistaxis and hematuria following cesarean delivery and platelet transfusions. A single expedited 3-liter plasma exchange procedure reversed the rapidly deteriorating clinical situation for each patient and accelerated recovery from HELLP syndrome. Both patients and progeny suffered no permanent sequelae.
  
  
  CONCLUSIONS
  Based on our experience, we believe that the therapeutic modality of plasma exchange with fresh frozen plasma can be employed effectively for the pregnant patient with severe atypical HELLP syndrome that progressively worsens during labor or the early puerperium despite the use of conventional transfusion therapy.
authors.affiliation: Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson 39216-4505.
authors.forename: J N
authors.initials: JN
authors.lastname: Martin
authors.forename: K G
authors.initials: KG
authors.lastname: Perry
authors.forename: W E
authors.initials: WE
authors.lastname: Roberts
authors.forename: J C
authors.initials: JC
authors.lastname: Files
authors.forename: P F
authors.initials: PF
authors.lastname: Norman
authors.forename: J C
authors.initials: JC
authors.lastname: Morrison
authors.forename: P G
authors.initials: PG
authors.lastname: Blake
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D017359:HELLP Syndrome / Q000628:therapy*; D006801:Humans; D010951:Plasma Exchange; D011225:Pre-Eclampsia / Q000628:therapy*; D011247:Pregnancy