HELLP Sendromunun Yönetiminde Terapötik Plazma Değişiminin Etkinliğinin Değerlendirilmesi: Tek Merkez Deneyimi

Year 2023, Volume: 37 Issue: 2, 153 - 160, 06.09.2023

İbrahim Halil Açar , Birol Güvenç

https://doi.org/10.18614/deutip.1277434

Abstract

HELLP sendromu, hemoliz, yüksek karaciğer enzimleri ve düşük trombosit sayısı ile karakterize, gebelikle ilişkili ciddi bir komplikasyondur. Kompleman düzensizliği, HELLP sendromunun etiyopatogenezine katkıda bulunur. Terapötik plazma değişimi (TPE), anormal kompleman yolu bileşenlerini ortadan kaldırır ve bunları normal fizyolojik bileşenlerle değiştirir. Bu çalışma, destekleyici tedavi ve kortikosteroidlere yanıt vermeyen HELLP sendromlu hastalarda TPE'nin hastalığın ilerlemesi üzerindeki etkisini değerlendirmeyi amaçladı. Bu retrospektif çalışma, Mississippi sistemine göre Sınıf 1 HELLP sendromu teşhisi konan 13 hastayı içermektedir. Bu hastalara 2012-2015 yılları arasında doğum sonrası dönemde TPE uygulandı. On üç hastadan üçü çoklu organ yetmezliğinden öldü. TPE sonrası hemoglobin ve trombosit sayıları artarken AST, ALT ve LDH seviyeleri azaldı. Bu değişiklikler istatistiksel olarak anlamlıydı (p<0.05). TPE sonrası ölen hastalarda hastaneye yatış ile TPE uygulanması arasındaki süre daha uzundu. TPE, konservatif tedaviye yanıt vermeyen kompleks doğum sonrası HELLP sendromlu hastalarda klinik sonuçları iyileştiren etkili bir tedavi stratejisidir. Bu tür vakalarda erken tanı ve TPE'nin hastalık yönetimindeki rolü giderek önem kazanmaktadır.

Keywords

HELLP sendromu, terapötik plazma değişimi, klinik sonuçlar

Supporting Institution

YOK

Project Number

YOK

Thanks

Çukurova Üniversitesi Tıp Fakültesi Hematoloji kliniği ve Patoloji kliniğine teşekkür ederiz

Evaluating the Efficacy of Therapeutic Plasma Exchange in the Management of HELLP Syndrome: A Single-Center Experience

Abstract

HELLP syndrome is a severe pregnancy-related complication characterized by hemolysis, elevated liver enzymes, and low platelet count. Complement dysregulation contributes to the etiopathogenesis of HELLP syndrome. Therapeutic plasma exchange (TPE) removes abnormal complement pathway components and replaces them with normal physiological components. This study aimed to evaluate the impact of TPE on disease progression in HELLP syndrome patients unresponsive to supportive therapy and corticosteroids. This retrospective study involved 13 patients diagnosed with Class 1 HELLP syndrome based on the Mississippi system. These patients underwent TPE in the postpartum period between 2012 and 2015. Of the thirteen patients, three succumbed to multiorgan failure. After TPE, hemoglobin and platelet counts increased, while AST, ALT, and LDH levels decreased. These changes were statistically significant (p<0.05). In patients who died after TPE, the duration between hospital admission and TPE initiation was longer. TPE is an effective treatment strategy that improves clinical outcomes in patients with complex postpartum HELLP syndrome who do not respond to conservative management. Early diagnosis and the role of TPE in disease management are increasingly important in such cases.

Keywords

HELLP syndrome, therapeutic plasma exchange, clinical outcomes

Project Number

YOK

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