Martin J N, Perry K G, Roberts W E, Files J C, Norman P F, Morrison J C, Blake P G
Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson 39216-4505.
J Clin Apher. 1994;9(3):162-5. doi: 10.1002/jca.2920090303.
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.
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.
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.
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.
探讨血浆置换作为一种辅助干预治疗手段，在重度子痫前期/子痫及溶血、肝酶升高和血小板减少（HELLP）综合征患者分娩前或产后立即使用的潜在疗效。
两名患有重度子痫前期/子痫/HELLP综合征并发症的孕妇在围产期立即接受紧急治疗，使用IBM 2997细胞分离器进行单容量血浆置换和新鲜冰冻血浆补液。
尽管多次输注血小板单位，一名孕39周、宫颈扩张5cm且处于活跃期的初产妇血小板计数仍为14,000/微升，并开始从针眼处渗血。另一名初产妇在剖宫产和输注血小板后仍昏迷、少尿且血小板减少，并出现鼻出血和血尿。一次快速的3升血浆置换程序扭转了每名患者迅速恶化的临床状况，并加速了从HELLP综合征中的恢复。两名患者及其后代均未留下永久性后遗症。
基于我们的经验，我们认为对于患有重度非典型HELLP综合征的孕妇，尽管使用了传统输血治疗，但在分娩期间或产褥早期病情仍逐渐恶化，血浆置换联合新鲜冰冻血浆的治疗方式可有效应用。
