The effectiveness of plasmapheresis treatment in the patients with HELLP Syndrome and eclampsia in the intensive care unit

Öz

Objective: In our study we aimed to state the effectiveness of plasmapheresis treatment in the patients with HELLP Syndrome and eclampsia in the intensive care unit. Methods: Patients who are with the diagnosis of HELLP Syndrome and eclampsia in our intensive care unit between the years of 2005-2010 were reviewed retrospectively. The patients\' characteristics, before and post-plasmapheresis biochemical and hematological values, urine outputs, APACHE II (Acute Physiology and Chronic Health Evaluation System), GCS, (Glasgow Coma Scoring), SOFA (Sequential Organ Failure Assessment) and MODS Scoring (Multiple Organ Dysfunction Score) are recorded. The effectiveness of plasmapheresis is evaluated. Results: 8 were HELLP Syndrome and 6 were eclampsia of 16 patients. The mean age was 29,5(±5,9). 2 of 6 eclampsia patients and, 1of 8 HELLP Syndrome patient were died. Age, APACHE II, MODS, GCS and the urine output are the significant clinical factors that determines the mortality (p

Anahtar Kelimeler

• HELLP Syndrome, Eclampsia, Plasmapheresis

The effectiveness of plasmapheresis treatment in the patients with HELLP Syndrome and eclampsia in the intensive care unit

Öz

Amaç: Çalışmamızda yoğun bakım ünitemizde HELLP Sendromu ve eklampsi tanılarıyla izlenen hastalara uygulanan plazmaferez tedavisinin etkinliği ortaya konulmuştur. Yöntemler: 2005-2010 yılları arasında yoğun bakım ünitemizde izlenen ve plazmaferez uygulanan HELLP Sendromu ve eklampsi hastalarının tedavi öncesi demografik özellikleri, plazmaferez öncesi ve sonrası fizik muayene bulguları, biyokimyasal parametreleri, hematolojik bulguları, arter kan gazı değerleri, idrar çıkışları APACHE II (Acute Physiology and Chronic Health Evaluation System), GKS, (Glasgow Koma Skorlaması), SOFA (Sequential Organ Failure Assessment) ve MODS skorlaması (Multiple Organ Dysfunction Score) kaydedildi. Yapılan plazmaferez tedavisi sonrası işlemin etkinliği değerlendirildi. Bulgular: 16 hastanın 8\'i HELLP Sendromu, 6\'sı eklampsi tanılarıyla takip edildi. Hastaların yaş ortalaması 29,5(±5,9) idi. Eklampsi tanısıyla takip edilen 6 hastadan 2\'si, HELLP Sendromu tanısı ile takip edilen 8 hastadan 1\'i yaşamını yitirmiştir. Yaş, yoğun bakıma alındığı andaki APACHE II, MODS, GKS ve hastanın mevcut idrar miktarı mortaliteyi belirleyen parametrelerdir (p

Anahtar Kelimeler

• HELLP Sendromu, Eklampsi, Plazmaferez

Kaynakça

1. Gary C, Norman FG, Kenneth JL, et al. Williams Obstetrics 2001;567-618.
2. Duley L. Maternal mortality associated with hypertensive disorders of pregnancy in Africa, Asia, Latin America and the Caribbean. British Journal of Obstetrics and Gynecol- ogy 1992;99:547-53.
3. Sibai B, Dekker G, Kupferminc M. Pre-eclampsia. Lancet 2005;4;365(9461):785-799.
4. Sibai BM. Preeclampsia-Eclampsia. Current Problems in Obstetrics and Gynecology and Fertility 1990;13:1-45,
5. ACOG practice bulletin. Diagnosis and management of pre- eclampsia and eclampsia. Obstet Gynecol 2002;99:159-167
6. Özler A, Evsen SE, Tan P. et al. Long-term changes in sexual functions following complicated pregnancies and deliver- ies. J Clin Exp Invest 2013;4:429-435
7. Alvarez Navascues R, Marin R. Severe maternal complica- tions associated with preeclampsia: an almost forgotten pa- thology? Nefrologia 2001;21:565-573,
8. Weinstein L. Syndrome of hemolysis, elevated liver enzymes, and low platelet count: a severe conseqence of hypertension in pregnanacy. Am J Obstet Gynecol 1982;142:159-167.

9. Agishi T. Spectrum of blood purification. Prog Med 1985;134:861-864.
10. Huestis DW, Bove JR, Busch S. Practical Blood Transfu- sion. 3rd ed. Boston: Little, Brown,and Co. 1981:315-172.
11. Barnes A. Hemapheresis perspectives. In:Kolins J, Jones JM (eds). Therapeutic Apheresis. Arlington. Virginia: American Association of Blood Banks 1983:1-13.
12. Volkin RL, Starz TW, Winkelstein A. et al. Changes in co- agulation factors, complement, immunglobulins, and im- mune complex concentration with plasma exchange. Trans- fusion 1982;22:54-58.
13. Huppertz B, Frank HG, Kingdom JC, et al. Villous cytotro- phoblast regulation of the syncytial apoptotic cascade in the human placenta. Histochem Cell Biol 1998;110:495-508.
14. Aly AS, Khandelwal M, Zhao J, et al. Neutrophils are stim- ulated by syncytiotrophoblast microvillous membranes to generate superoxide radicals in women with preeclampsia. Am J Obstet Gynecol 2004;190:252-258.
15. Benyo DF, Samarason A, Redman CW, et al. Expression of inflammatory cytokines in placentas from women with pre- eclampsia. J Clin Endocrinol Metab 2001;86:2505-2512.
16. Neale D, Demasio K, Illuzi J, et al. Maternal serum of women with preeclampsia reduces trophoblast cell viabil- ity: evidence for an increased sensitivity to Fas-mediated apoptosis. J Matern Fetal Neonatal Med 2003;13:39-44.
17. Martin JN Jr, Blake PG, Lowy SL, et al. Pregnancy compli- cated by pre-eclampsia-eclampsia with syndrome of hemo- lysis, elevated liver enzymes and low platelet count: How rapid is postpartum recovery? Obstet Gynecol 1990;76:737.
18. Martin JN Jr, Rinehart BK, May WL, et al. The spectrum of severe preeclampsia: Comparative analysis by HELLP (hemolysis, elevated liver enzyme levels, and low plate- let count) syndrome classification. Am J Obstet Gynecol 1999;180:1373.
19. Padden MO. HELLP syndrome: Recognition and perinatal management. Am Fam Physician 1999;60:829.
20. Barton JR, Riely CA, Adamec TA, et al. Hepatic histopatho- logic condition does not correlate with laboratory abnor- malities in HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count). Am J Obstet Gynecol 1992;167:1538.
21. Sibai BM, Ramadan MK, Usta I, et al. Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome). Am J Obstet Gynecol 1993;169:1000.
22. Taner CE, Erden AC, Kocabaglı C, et al. HELLP send- romu: 12 olgu ve tedavide yaklasimlar. Turkiye Klinikleri Jinekoloji ve Obstetrik Dergisi 1993;3:129.
23. Isler CM, Rinehart BK, Terrone DA, et al. Maternal mortal- ity associated with HELLP (hemolysis, elevated liver en- zymes, and low platelets) syndrome. Am J Obstet Gynecol 1999;181:924.
24. Wolf JL. Liver disease in pregnancy. Med Clin North Am 1996;80:1167.
25. Eser B, Guven M , Unal A, et al. The Role of Plasma Ex- change in HELLP Syndrome. Clin Appl Thrombosis/He- mostasis 11:211–217,2005.