Therapeutic Plasma Exchange in HELLP Syndrome: Emerging Insights and Clinical Applications

Therapeutic plasma exchange produced rapid clinical reversal in a critically ill postpartum patient with refractory thrombotic microangiopathy/HELLP, restoring platelet counts, improving liver tests, and reversing renal impairment after standard care failed. The intervention achieved prompt organ‑function stabilization and represents a potential life‑saving rescue option when other measures were ineffective.

A 22‑year‑old woman presented postpartum after abruptio placentae with persistent oliguria, dyspnea, severe anemia, thrombocytopenia, transaminitis, and progressive renal dysfunction despite initial conservative management and intermittent hemodialysis for oliguria. Clinical deterioration despite ICU‑level supportive care prompted escalation to therapeutic plasma exchange.

Seven TPE sessions were administered and were followed by rapid normalization of platelet counts, marked reduction in transaminases, and progressive improvement in renal function over several days; adjunctive supportive therapies continued throughout. The clinical course demonstrated fast, measurable laboratory and organ recovery after TPE initiation, culminating in short‑term maternal stabilization.

The series of seven TPE treatments was delivered alongside standard supportive measures for a case of postpartum HELLP syndrome, with serial laboratory monitoring and renal replacement as needed. The report did not specify replacement fluid, vascular access site/type, or anticoagulation strategy.

Earlier initiation of TPE in this patient correlated with quicker hematologic and renal recovery; this single‑case observation cannot establish causality. Larger, systematic studies are required to determine whether earlier TPE shortens time to organ recovery.

Key Takeaways:

• What’s new? TPE functioned as an effective rescue therapy in refractory postpartum HELLP with measurable platelet, liver‑test, and renal recovery.
• Who’s affected? Critically ill postpartum patients with refractory HELLP or thrombotic microangiopathy who do not respond to standard measures.
• What changes next? Consider expedited multidisciplinary escalation to TPE in comparable refractory cases and ensure operational readiness — apheresis capability, plasma supply, and structured monitoring should be in place.