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Background <p>The occurrence of hemolysis, elevated liver enzymes, and low platelet count is HELLP syndrome. HELLP in post partum period is more grave and difficult to treat than HELLP syndrome during pregnancy. We describe a case of postpartum HELLP syndrome that responded to therapeutic plasma exchange (TPE) therapy.</p> Case presentation <p>A 22-year-old woman,G3P1A1L1,presented with sudden abdominal pain and bleeding due to abruptio placentae and intrauterine fetal demise at seven months gestation in her third pregnancy at a peripheral hospital. Post delivery, she experienced decreased urine output and was referred due to persistent oliguria and shortness of breath. Initial investigations revealed severe anemia, thrombocytopenia, and renal dysfunction. Despite conservative management, her renal function deteriorated, prompting admission to the ICU and initiation of hemodialysis. In view of the advent of refractory postpartum thrombotic microangiopathy, therapeutic plasma exchange (TPE) was initiated. With seven sessions of TPE and adjunct supportive therapy, patient improved clinically. In addition, there was significant improvement in renal function, correction of anemia and thrombocytopenia.</p> Conclusion <p>Though the clinical decision to initiate TPE therapy in the management of severe postpartum HELLP syndrome is taken when all other modalities are ineffective, it is suggested that early initiation of TPE can prove to be life saving measure. This case highlights the effectiveness of timely TPE in treating severe postpartum HELLP syndrome.</p>

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Therapeutic Plasma Exchange in HELLP Syndrome: Turning The Tide In Critical Care

  • 期刊论文

  • 发表日期：

    2025年12月19日

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  • Gloriya Cheriyan,
  • Vanamala A. Alwar,
  • A. M. Shanthaladevi

摘要

Background

The occurrence of hemolysis, elevated liver enzymes, and low platelet count is HELLP syndrome. HELLP in post partum period is more grave and difficult to treat than HELLP syndrome during pregnancy. We describe a case of postpartum HELLP syndrome that responded to therapeutic plasma exchange (TPE) therapy.

Case presentation

A 22-year-old woman,G3P1A1L1,presented with sudden abdominal pain and bleeding due to abruptio placentae and intrauterine fetal demise at seven months gestation in her third pregnancy at a peripheral hospital. Post delivery, she experienced decreased urine output and was referred due to persistent oliguria and shortness of breath. Initial investigations revealed severe anemia, thrombocytopenia, and renal dysfunction. Despite conservative management, her renal function deteriorated, prompting admission to the ICU and initiation of hemodialysis. In view of the advent of refractory postpartum thrombotic microangiopathy, therapeutic plasma exchange (TPE) was initiated. With seven sessions of TPE and adjunct supportive therapy, patient improved clinically. In addition, there was significant improvement in renal function, correction of anemia and thrombocytopenia.

Conclusion

Though the clinical decision to initiate TPE therapy in the management of severe postpartum HELLP syndrome is taken when all other modalities are ineffective, it is suggested that early initiation of TPE can prove to be life saving measure. This case highlights the effectiveness of timely TPE in treating severe postpartum HELLP syndrome.