Treatment of thrombotic microangiopathy in pregnancy with plasma exchange: a report of two cases.

Thrombotic microangiopathy is a rare disease that can be induced and precipitated by pregnancy, and is associated with high maternal and fetal morbidity and mortality. It results from abnormal intravascular platelet aggregation that leads to transient ischemia in various organs, including the central nervous system, kidneys and placenta. Plasma exchange is the most widely accepted method of treatment for this condition. Delayed diagnosis is the main reason for morbidity and mortality, and results from difficulty in differentiating thrombotic microangiopathy from other obstetric emergencies. We report two cases of thrombotic microangiopathy that occurred antepartum and postpartum, respectively. The first patient was a 33-year-old woman who had two previous episodes of intrauterine fetal death in the 13th and 28th weeks of gestation, respectively. She received early plasma exchange at the 23rd week of gestation during this pregnancy and the fetus was delivered uneventfully. The second patient was a 28-year-old woman with progressive thrombocytopenia, anemia and deterioration of renal and liver function postpartum. She received early plasma exchange and it markedly improved her thrombocytopenia without sequelae. In conclusion, early diagnosis and early initiation of plasmapheresis may improve both maternal and fetal prognosis in thrombotic microangiopathy.     

妊娠及产后血栓性微血管病

血栓性微血管病(thrombotic microangiopathy,TMA)是一组以微血管栓塞为病理特征的疾病.主要表现为微血管病性溶血性贫血、血小板减少、微循环血小板血栓引起神经系统、肾脏等器官受累[1].经典的血栓性微血管病主要指血栓性血小板减少性紫癜(TTP)和溶血性尿毒综合征(HUS).TTP和HUS均有溶血...     

Solvent-detergent plasma as replacement therapy in a pregnant patient with factor V deficiency.

This case illustrates the successful treatment of factor V deficiency in pregnancy using solvent-detergent plasma.     

Treatment of persistent postpartum HELLP syndrome with plasmapheresis.

Thrombocytopenia, associated with microangiopathic disease, is one characteristic of severe preeclampsia. Thrombocytopenia and intravascular hemolysis usually resolve by postpartum days 4 to 5. When thrombocytopenia secondary to microangiopathic disease persists, plasmapheresis may be used to arrest and reverse the process. Three patients over a 24-month period were successfully treated with plasma exchange with fresh frozen plasma. Several investigators who have cared for patients with persistent thrombocytopenia associated with preeclampsia have concluded that early plasmapheresis may be useful therapy. Plasma exchange should also be considered as a therapeutic option when clinical deterioration occurs due to microangiopathic disease.     

Intensive plasma exchange as an adjunct to management of severe rhesus disease

Large-volume plasma exchange was used to reduce the maternal anti-D concentration in a case of severe rhesus disease. The treatment commenced at 19 weeks' gestation and continued until the infant was successfully delivered at 35.2 weeks' gestation. The initial anti-D level of 30 IU/ml was lowered to 10 and was maintained below that level, with few exceptions throughout the program. The volume of plasma exchanged each week varied between 6.8 and 13.4 liters, a total of 154 l. Three IUTs were accomplished, starting from 31 weeks' gestation. The patient's OD values remained far below those recorded in her previous pregnancy which terminated in neonatal death. The replacement fluids consisted of 98 l PPS with FFP added to equilibrate the patient at the end of each procedure, altogether 33 l. At 33 weeks' gestation she developed a transient non-A, non-B hepatitis probably caused by the use of FFP. However, she later made a complete recovery. Large-volume plasma exchanges commenced early in high-risk pregnancy must be individually designed and based on the kinetics of anti-D production. The replacement fluids should preferably consist of pasteurized albumin solutions and intravenous immune globulin.     

Fatigue as a predictor of postpartum depression

BACKGROUND: The postpartum is a time when women commonly report increased fatigue that may contribute to depression. Studies have not examined fatigue alone as a predictor of postpartum depression. OBJECTIVE: To examine whether and when fatigue in the early postpartum is predictive of postpartum depression. Design: Correlational, longitudinal study. SETTING: Two hospitals and participants' homes in central Pennsylvania. PARTICIPANTS: Convenience sample of 38 healthy women recruited from hospital maternity units within 24 hours after an uncomplicated birth. MAIN OUTCOME MEASURES: Fatigue was measured using the Modified Fatigue Symptom Checklist (MFSC) on Days 0, 7, 14, and 28 after childbirth. Depression was assessed using the Center for Epidemiological Studies-Depressive Symptomatology Scale (CES-D) on Day 28. RESULTS: After adjustments for multiple comparisons, a significant correlation was obtained between fatigue as measured by the MFSC and postpartum depression on Day 7 (r = .46; p < .05), Day 14 (r = .57), and Day 28 (r = .70). Fatigue on Day 0 was correlated with fatigue on Day 7 (r = .45), Day 14 (r= .58), and Day 28 (r = .34). CONCLUSIONS: Fatigue as early as 7 days postpartum is predictive of depression at Day 28 postpartum.     

The recovery of normal plasma progesterone levels in the postpartum female

The return of fertility in postpartum women is gradual. This may be related to ovarian hormonal deficiencies, in particular, inadequate stimulation of the endometrium by progesterone (P). The purpose of this study was to evaluate the recovery of normal luteal function in four postpartum women who were followed for four cycles with serum P, follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and prolactin (PRL) taken three times weekly. PRL decreased immediately after delivery and was at normal levels before the first cyclic increases in serum LH and P. E2 and FSH cyclic changes were identical over the four menstrual cycles. LH peak values rose consistently from the first to the fourth cycle. P increased statistically each subsequent cycle in all parameters studied. These parameters of P were peak levels, days to the peak, duration of the luteal phase, and area under the P curve. The postpartum woman thus seems an excellent model for the study of ovarian hormonal disorders, particularly as they relate to disordered luteal P.     

Pregnancy in a homozygous familial hypercholesterolemic patient treated with long-term plasma exchange

We describe the first pregnancy in a homozygous familial hypercholesterolemic woman who started plasma exchange therapy 3 years before she became pregnant. We especially studied the effects of plasma exchange on lipid profile, uteroplacental circulation, and pregnancy course.     

血浆置换在治疗妊娠期急性脂肪肝中的应用价值

目的探讨血浆置换在治疗妊娠期急性脂肪肝的中的应用价值。 方法对2010年1月至2013年12月中山大学附属第三医院产科收治的17例采用血浆置换治疗妊娠期急性脂肪肝患者的临床资料进行回顾性分析,分析患者治疗前后的临床症状、体征、肝肾功能、凝血等指标,以及血浆置换出现的副作用。 结果(1)患者治疗前后各项检查指标的比较：白细胞(20.2±9.1)×10⁹/L与(15.2±5.9)×10⁹/L、天冬氨酸转氨酶(304.3±312.6)U/L与(81.4±99.5)U/L、丙氨酸转氨酶(332.5±348.3)U/L与(116.7±198.9)U/L、总胆红素(130.5±113.6)μmol/L与(84.3±35.5)μmol/L、凝血酶原时间(22.5±6.3)s与(19.6±6.7)s、尿素(9.6±7.8) mmol/L与(7.6±4.2)mmol/L、尿酸(515.3±167.0)μmol/L与(380.0±219.4)μmol/L,均得到明显改善(P值均<0.05);(2)血浆置换副作用小,未出现因不良反应而终止血浆置换治疗的病例。 结论血浆置换用于治疗妊娠期急性脂肪肝具有安全、有效等特点,在及时终止妊娠后使用血浆置换可有效遏制病情的发展。     

Personality traits in women 4 days postpartum and their correlation with plasma levels of oxytocin and prolactin

The aim of the present investigation was to explore whether the personality characteristics of women who have recently given birth differ from those of a control group of similar aged women and if so, whether such deviations are related to the pregnancy- and lactation-associated hormones oxytocin and prolactin which in animal experiments have been shown to play a role in maternal behavior. Thereforethe Karolinska Scales of Personality (KSP) were used in 50 women 4 days postpartum and in addition 18 blood samples were drawn in connection with breastfeeding. Oxytocin and prolactin levels were measured by radioimmunoassay. The women investigated scored lower in Muscular Tension (p < 0.05), in Monotony Avoidance (p < 0.001) and Psychasthenia (p < 0.01) and higher in Social Desirability (p < 0.001) than a reference material. Plasma levels of oxytocin and prolactin rose as expected in response to breastfeeding. When the average prolactin and oxytocin levels obtained at the 18 different timepoints of each woman were correlated with the scores obtained in the various KSP items, some significant relationships were found. Significant positive correlations were found between prolactin and the KSP dimensions Social Desirability and Inhibited Aggression and negative correlations with Psychasthenia. Significant inverse relationships between oxytocin and several Anxiety and Aggression variables, Guilt in particular, were also found. Correlations with oxytocin and prolactin levels were as a rule particularly clear in samples collected during breastfeeding. The data obtained are discussed from a biological point of view in relation to the specific 'maternal behavior' described in other mammals. It is suggested that subtle psychological and behavioral changes occur in women during motherhood and that these changes may in part be related to prolactin and oxytocin.     

血浆置换治疗小儿溶血尿毒综合征疗效及随访研究

摘要：目的　探讨儿童溶血尿毒综合征（HUS）患儿的临床特点,观察血浆置换在儿童HUS中的治疗效果和随访。方法　研究对象为2001年1月至2007年11月在中国医科大学附属盛京医院儿肾科住院的9例HUS患儿,分析其首发症状和实验室检查,药物治疗经过,血浆置换或联合血液透析治疗的效果,病情好转后口服糖皮质激素治疗的转归及随访（0.5～6年）结果。结果　腹泻相关的HUS（D+）和非典型HUS（D-）患儿临床特点和实验室检查无明显差异;在综合药物治疗不能缓解病情时应早期进行血浆置换,一般置换1次可以阻止病情进展,重症增加1次并联合血液透析可取得较好疗效;序贯口服糖皮质激素有助于降低尿蛋白,促进肾脏损伤的恢复。随访中1例出现蛋白尿,重复肾活检出现肾小管间质损伤和免疫物质增多;1例出现高血压。结论　血浆置换治疗小儿HUS临床疗效显著,序贯口服糖皮质激素有助于降低尿蛋白,HUS患儿的长期随访需引起儿肾科医生的关注。