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A Fibrin-Enriched and tPA-Sensitive Photothrombotic Stroke Model
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Published on: June 4, 2021

Postpartum thrombotic microangiopathic syndrome.

Michelle Y Owens1, James N Martin, Kedra Wallace

  • 1Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Winfred L. Wiser Hospital for Women and Infants, University of Mississippi Medical Center, 2500 N. State St., Jackson, MS 39216, United States. myowens@umc.edu

Transfusion and Apheresis Science : Official Journal of the World Apheresis Association : Official Journal of the European Society for Haemapheresis
|June 19, 2012
PubMed
Summary

Plasma exchange effectively treated postpartum thrombotic microangiopathy syndromes resembling HELLP syndrome, improving platelet counts and liver enzymes, with a 78% maternal survival rate.

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Area of Science:

  • Obstetrics and Gynecology
  • Hematology
  • Critical Care Medicine

Background:

  • Thrombotic microangiopathies (TMAs) with hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome-like features pose life-threatening risks.
  • Medical therapy is often insufficient for severe postpartum TMAs.

Purpose of the Study:

  • To characterize postpartum TMAs with HELLP-like features.
  • To evaluate the efficacy of postpartum plasma exchange (PPEX) in these conditions.

Main Methods:

  • Retrospective study of patients treated with PPEX between 1994 and 2008.
  • Analysis of clinical data from nine patients treated in-house and nineteen from published literature.

Main Results:

  • PPEX demonstrated a 78% maternal survival rate.
  • Treatment significantly increased platelet levels (p=0.048).
  • PPEX significantly decreased serum lactic dehydrogenase (p=0.0012) and aspartate aminotransferase (p=0.0001).

Conclusions:

  • Five distinct categories of postpartum TMA syndromes meeting HELLP criteria were identified.
  • These syndromes appear to respond favorably to PPEX.