[Successful application of recombinant activated factor VII in a patient with HELLP syndrome and disseminated intravascular coagulation].
BACKGROUND
HELLP syndrome represents the form of preeclampsia characterized by moderate hypertension, often with absence of proteinuria and oedema. The frequency of HELLP syndrome in pregnant women with preeclampsia is 10-20%. The clinical course of the disease is characterized by the progressive worsening of mother and fetus condition, which can be stopped only by delivery. Disseminated intravascular coagulation is present in 8% of patients with HELLP syndrome and causes significant morbidity and mortality.


METHODS
We present a case of HELLP syndrome complicated by intrauterine fetal demise and disseminated intravascular coagulation in trigemelar pregnancy. After all surgical and medicamentous methods to establish haemostasis were exhausted, the patient was treated by recombinant activated factor VII (rFVIIa) in intravenous bolus dose of 90 microg/kg twice, which resulted in satisfactory haemostasis. Side effects of the drug were not registered.


CONCLUSIONS
The application of rFVIIa reduced haemorrhage in our patient, both after the Caesarean section and after hysterectomy, contributing to the patient's full recovery, without neurological sequelae and with preserved renal function. RFVIIa is not an alternative to surgical haemostasis, but its administration should surely be considered before deciding to perform hysterectomy, especially in patients who want to preserve fertility. In cases of postpartum haemorrhage, when bleeding persists even after adequate surgical haemostasis, the administration of rFVIIa is to be considered not only as an alternative to hysterectomy, but also an effort to prevent significant maternal morbidity and mortality.
Ilić-Mostić
Tatjana
T
Institute for Anesthesia and Reanimation, Clinical Centre of Serbia, Belgrade. dmostic@sbb.co.yu
Argirović
Rajka
R
Sparić
Radmila
R
Ljubić
Aleksandar
A
Bozanović
Tatjana
T
Jeremić
Katarina
K
Tomanović-Koković
Jelena
J
Kadija
Sasa
S
D000328:Adult; D016063:Blood Loss, Surgical; D002585:Cesarean Section; D004211:Disseminated Intravascular Coagulation / Q000150:complications*; D015942:Factor VIIa / Q000627:therapeutic use*; D005260:Female; D017359:HELLP Syndrome / Q000097:blood*; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D006473:Postpartum Hemorrhage / Q000188:drug therapy*; D011247:Pregnancy; D011994:Recombinant Proteins / Q000627:therapeutic use
D006490:Hemostatics; D011994:Recombinant Proteins; C103587:recombinant FVIIa; D015942:Factor VIIa