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An association between refractory HELLP syndrome and antiphospholipid antibodies during pregnancy; a report of 2 cases.
J Rheumatol. 1994 Jul; 21(7):1360-4.JR

Abstract

The HELLP syndrome (hemolysis, elevated liver enzymes and low platelets) is a thrombotic microangiopathic vasculopathy that presents in pregnancy. HELLP syndrome usually resolves with delivery of the fetus without sequelae and is often managed successfully with conservative care. To our knowledge, there has been no prior report of an association between HELLP syndrome and elevated titers of antiphospholipid antibodies (aPL). We describe 2 patients who each presented with HELLP syndrome that was refractory despite delivery of the fetus, corticosteroids, and anticoagulation. Both patients had elevated levels of anticardiolipin antibodies. Examination of skin and placental pathology revealed diffuse deposition of fibrin with small vessel thrombi, without evidence of vasculitis. Coincident with plasmapheresis, HELLP resolved in both patients. We conclude that there may be an association between the presence of aPL and a protracted HELLP syndrome in pregnancy; this may be a new manifestation of the antiphospholipid syndrome. Plasmapheresis appears to benefit these patients. Further investigation into this association is warranted.

Authors+Show Affiliations

Ornstein MH
Department of Medicine, Mount Sinai School of Medicine, New York, NY 10029.
Rand JH
No affiliation info available

MeSH

Adrenal Cortex HormonesAdultAntibodies, AntiphospholipidAnticoagulantsDelivery, ObstetricFemaleHELLP SyndromeHumansPlasmapheresisPregnancyPregnancy Complications, HematologicTomography, X-Ray Computed

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

7966086

Citation

Ornstein, M H., and J H. Rand. "An Association Between Refractory HELLP Syndrome and Antiphospholipid Antibodies During Pregnancy; a Report of 2 Cases." The Journal of Rheumatology, vol. 21, no. 7, 1994, pp. 1360-4.
Ornstein MH, Rand JH. An association between refractory HELLP syndrome and antiphospholipid antibodies during pregnancy; a report of 2 cases. J Rheumatol. 1994;21(7):1360-4.
Ornstein, M. H., & Rand, J. H. (1994). An association between refractory HELLP syndrome and antiphospholipid antibodies during pregnancy; a report of 2 cases. The Journal of Rheumatology, 21(7), 1360-4.
Ornstein MH, Rand JH. An Association Between Refractory HELLP Syndrome and Antiphospholipid Antibodies During Pregnancy; a Report of 2 Cases. J Rheumatol. 1994;21(7):1360-4. PubMed PMID: 7966086.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - An association between refractory HELLP syndrome and antiphospholipid antibodies during pregnancy; a report of 2 cases. AU - Ornstein,M H, AU - Rand,J H, PY - 1994/7/1/pubmed PY - 1994/7/1/medline PY - 1994/7/1/entrez SP - 1360 EP - 4 JF - The Journal of rheumatology JO - J Rheumatol VL - 21 IS - 7 N2 - The HELLP syndrome (hemolysis, elevated liver enzymes and low platelets) is a thrombotic microangiopathic vasculopathy that presents in pregnancy. HELLP syndrome usually resolves with delivery of the fetus without sequelae and is often managed successfully with conservative care. To our knowledge, there has been no prior report of an association between HELLP syndrome and elevated titers of antiphospholipid antibodies (aPL). We describe 2 patients who each presented with HELLP syndrome that was refractory despite delivery of the fetus, corticosteroids, and anticoagulation. Both patients had elevated levels of anticardiolipin antibodies. Examination of skin and placental pathology revealed diffuse deposition of fibrin with small vessel thrombi, without evidence of vasculitis. Coincident with plasmapheresis, HELLP resolved in both patients. We conclude that there may be an association between the presence of aPL and a protracted HELLP syndrome in pregnancy; this may be a new manifestation of the antiphospholipid syndrome. Plasmapheresis appears to benefit these patients. Further investigation into this association is warranted. SN - 0315-162X UR - https://www.unboundmedicine.com/medline/citation/7966086/An_association_between_refractory_HELLP_syndrome_and_antiphospholipid_antibodies_during_pregnancy L2 - http://www.diseaseinfosearch.org/result/3266 DB - PRIME DP - Unbound Medicine ER -