title: Are there any additional mechanisms for haemolysis in HELLP syndrome?
abstract: HELLP syndrome is a microangiopathy that leads to severe maternal complications. The objective of this study was to identify any additional mechanisms that could have contributed to HELLP syndrome-induced haemolysis. This is a pilot, prospective and observational study that lasted 9months. All patients with HELLP syndrome treated at academic tertiary care women hospital accepted to participate. Sixteen patients were included. In ten patients (63%), schizocytes were detected following a blood smear test. Six patients (38%) were diagnosed with a partial expression deficiency of proteins regulating the complement system (CD 55 or CD 59). In nine patients (56%), an activation of the complement classical pathway was detected. In two patients (13%), an ADAMTS 13 activity below 30% was detected. Three patients (19%) were diagnosed with a folate deficiency and one (6%) with an antiphospholipid syndrome. All patients developed maternal or fetal morbidity including nine (56%) an acute kidney injury. All patients but one had at least one additional mechanism that could contribute to haemolysis, besides a simple physical injury. Larger studies should be promoted to understand haemolysis in HELLP syndrome.
authors.affiliation: Service d'Anesthésie-Réanimation Obstétricale, Pôle d'Anesthésie-Réanimation, France.
authors.forename: L
authors.initials: L
authors.lastname: Sabau
authors.affiliation: Institut d'Hématologie Transfusion, Centre Biologie Pathologie, France; Unité de Recherche EA2693, Université Lille Nord de France, Lille, France.
authors.forename: L
authors.initials: L
authors.lastname: Terriou
authors.affiliation: Pôle de néphrologie, France.
authors.forename: F
authors.initials: F
authors.lastname: Provot
authors.affiliation: Service de Réanimation Polyvalente, Pôle de réanimation, France.
authors.forename: F
authors.initials: F
authors.lastname: Fourrier
authors.affiliation: Institut d'Hématologie Transfusion, Centre Biologie Pathologie, France; Unité de Recherche EA2693, Université Lille Nord de France, Lille, France.
authors.forename: C
authors.initials: C
authors.lastname: Roumier
authors.affiliation: Institut d'Hématologie Transfusion, Centre Biologie Pathologie, France; Unité de Recherche EA2693, Université Lille Nord de France, Lille, France.
authors.forename: C
authors.initials: C
authors.lastname: Caron
authors.affiliation: Institut d'Hématologie Transfusion, Centre Biologie Pathologie, France; Unité de Recherche EA2693, Université Lille Nord de France, Lille, France.
authors.forename: S
authors.initials: S
authors.lastname: Susen
authors.affiliation: Service d'Anesthésie-Réanimation Obstétricale, Pôle d'Anesthésie-Réanimation, France.
authors.forename: A S
authors.initials: AS
authors.lastname: Ducloy-Bouthors
mesh_terms: D000071120:ADAMTS13 Protein / Q000097:blood; D058186:Acute Kidney Injury / Q000209:etiology; D000328:Adult; D016736:Antiphospholipid Syndrome / Q000150:complications; D018958:CD55 Antigens / Q000097:blood; D018957:CD59 Antigens / Q000097:blood; D003167:Complement Activation; D005260:Female; D005494:Folic Acid Deficiency / Q000150:complications; D017359:HELLP Syndrome / Q000097:blood / Q000276:immunology / Q000473:pathology*; D006461:Hemolysis; D006801:Humans; D010865:Pilot Projects; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D018958:CD55 Antigens; D018957:CD59 Antigens; D000071120:ADAMTS13 Protein
keywords: Acute kidney injury; Complement system; HELLP syndrome; Haemolysis