Rheological, hemostaseological changes during immunetherapy for prevention of HELLP-syndrome in a patient with elevated phospholipid antibodies.

摘要: OBJECTIVE Patients with a history of severe obstetric complications in the presence elevated phospholipid antibodies are at high risk for recurrent debacle. We report successful immunologic treatment prevention HELLP-Syndrome subsequent pregnancy patient Phospholipid antibodies, while under rheological and hemostaseological monitoring. METHODS The prior term reconfirmed her first received pooled immunoglobulins (Sandoglobulin 3 g - Novartis) intravenously immunological every three weeks addition to low molecular weight heparin (Clexane 40 mg/d s.c.) Aspirin (100 mg/d from 2nd trimester) during pregnancy. Before each 10 cycles blood parameters (Red Blood cell {RBC} aggregation stasis E0, shear E1, RBC deformability low-, moderate-, force, plasma viscosity {Pv}), as well thrombelastometry (ROTEM) vitro platelet function (PFA-100) evaluation was performed. At same times non-invasive, physical thrombosis screening took place using impedance plethysmography (Filtrass) RESULTS During constant increase PV E1 (>45 S -1) accompanied by delayed but continuous beginning end trimester. Thrombelastometry revealed reduction clot formation time (CFT; extem: 84 38 sec) an maximal firmness (MCF; 64 78 sec) after TF-induced coagulation activation MCF CFT contact (intem) barely unchanged. Platelet bleeding-time EPI/Coll stimulation temporary prolonged onset intake (>300 sec) normalized soon 20th gestational week, ADP/Coll trend towards bleeding time. There strong statistically significant inverse correlation between TF induced (r =-0.82; p = 0.002) positive (r = 0.89; p <  0.001), activated weak or absent, respectively. Until GW 38th routine laboratory- (Platelet-count, Haptoglobin, liver enzymes) clinical findings remained normal, without evidence reoccurrence development thrombosis. CONCLUSIONS immunotherapy this did not reoccur. aggregability closely related speed coagulation. 3rd trimester dramatically higher compared normal value range pregnant women found large recent trial which may have been early indicator imminent HELLP-Syndrome.