title: Recurrence of microangiopathic hemolytic anemia after apparent recovery from the HELLP syndrome. A case report.
abstract: BACKGROUND
  The syndrome of hemolytic anemia, elevated liver enzymes and low platelets (HELLP) can accompany preeclampsia and eclampsia. Delivery of the infant usually results in improvement in the mother's condition, with the recovery time dependent on the severity of the disease. We report a case of eclampsia with the HELLP syndrome in which microangiopathic hemolytic anemia (MAHA) and thrombocytopenia recurred after apparent recovery.
  
  
  METHODS
  A 28-year-old woman, gravida 4, para 0, therapeutic abortion 3, presented with signs and symptoms of severe preeclampsia and became eclamptic. The patient's condition improved as expected following cesarean delivery. However, the hemolytic anemia recurred and was successfully treated with a course of fresh frozen plasma (FFP).
  
  
  CONCLUSIONS
  Hemolytic anemia in women with eclampsia and the HELLP syndrome occurs secondary to microvascular endothelial damage. In this case resolution of the HELLP syndrome and eclampsia occurred, as expected, in two to three days; however, MAHA and low platelets recurred on day 4. Treatment of MAHA with FFP was successful.
authors.affiliation: Departments of Obstetrics and Gynecology, Medicine and Microbiology, Center for Molecular Biology, Loma Linda University Medical Center, Loma Linda, California, USA.
authors.forename: Frank
authors.initials: F
authors.lastname: Lombano
authors.forename: Melissa Y
authors.initials: MY
authors.lastname: Kidder
authors.forename: Michael
authors.initials: M
authors.lastname: Lilly
authors.forename: Yvonne G
authors.initials: YG
authors.lastname: Gollin
authors.forename: Barry S
authors.initials: BS
authors.lastname: Block
mesh_terms: D000328:Adult; D000743:Anemia, Hemolytic / Q000209:etiology* / Q000628:therapy; D016913:Blood Component Transfusion; D002585:Cesarean Section; D005260:Female; D017359:HELLP Syndrome / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D010949:Plasma; D011247:Pregnancy; D011256:Pregnancy Outcome; D011644:Puerperal Disorders / Q000209:etiology* / Q000628:therapy; D012008:Recurrence; D013921:Thrombocytopenia / Q000209:etiology* / Q000628:therapy