The aim of this study was to investigate the effectiveness of plasma exchange therapy in patients with various forms of hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome.

1. Plasma
therapy in HELLP syndrome

2. Apollo Medicine 2012 September
Volume 9, Number 3; p. 276 Journal Scan
Plasma therapy in HELLP syndrome
Director R.N. Makroo
Plasma exchange therapy in HELLP syndrome: a single-center experience. Ziya Bayraktaroglu, Fikret Demiric, Özcan
Balat, Irfan Kutlar, Vahap Okan, Gürol Ugur. Turk J Gastroenterol. 2006;17(2): 99e102.
Abstract:
Background: The aim of this study was to investigate the effectiveness of plasma exchange therapy in patients with various
forms of hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome.
Methods: During a 3-year period, 13 patients with HELLP syndrome were treated with one or two sessions of plasma exchange
after delivery. Diagnosis of hemolysis, elevated liver enzymes, and low platelets syndrome was made according to Sibai’s
criteria, and the severity of illness was categorized according to platelet counts. Among patients, nine were in class-1 and
the remaining four were in class-2. Patients with very high levels of aspartate aminotransferase (AST) (>2000 U/L) and lactate
dehydrogenase (LDH) (>3000 U/L) were defined as fulminant type (2 cases).
Results: Rapid improvement in platelet counts was observed after treatment with plasma exchange. All patients survived
except the two fulminant hemolysis, elevated liver enzymes, and low platelets syndrome cases.
Conclusions: In our study, plasma exchange therapy was effective in patients with severe hemolysis, elevated liver
enzymes, and low platelets syndrome, but fulminant cases did not appear to respond to this therapy.
COMMENTS
‘HELLP syndrome’ (hemolysis, elevated liver enzymes, and low platelets) is a potentially lethal complication of severe
preeclampsia. Therapeutic plasma exchange has emerged as an important treatment modality especially in patients with progres-sive
elevation of bilirubin or creatinine for over 72 h.
The authors have demonstrated with success, a good response to 1e2 sessions of plasma exchanges in most of their cases
except two, who succumbed to multi organ failure. A fairly good follow-up period of 3 months after discharge further substantiates
their results. They have also demonstrated that the procedure is not only effective but also safe, with only minimal adverse reac-tions
in 4 patients, which were not severe enough to interrupt the procedures.
The Indraprastha Apollo Hospitals, being an advanced tertiary care and referral center caters to a large number of patients
from all disciplines of medicine. With a busy plasma exchange programme, we successfully treat patients with renal, neurological
and hematological disorders among others. We have encountered 5 cases of HELLP syndrome in our experience so far. These
have been treated with 1e5 sittings of 1e1.5 volume exchanges each. Three patients were successfully treated and discharged in
stable condition, while 2 succumbed to their illness.
Departments of Pediatrics and Transfusion Medicine, Molecular Biology and Transplant Immunology, India.
email: makroo@apollohospitals.com
Received: 6.6.2012; Accepted: 29.6.2012; Available online: 7.7.2012
http://dx.doi.org/10.1016/j.apme.2012.06.005

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