Addition of platelet transfusions to corticosteroids does not increase the recovery of severe HELLP syndrome

Abstract

Objective The objective was to evaluate the effect of dexamethasone and platelet transfusion treatment on recovery in patients with class 1 hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome. Material and methods All women with class 1 HELLP syndrome (true HELLP syndrome) who were seen at the hospital Complejo Hospitalario de la Caja de Seguro Social de Panama, Panama between July 1996 and June 2004 took part in a retrospective, comparative study. They were divided into two groups. One group received dexamethasone and the other group received dexamethasone plus platelet transfusion. True HELLP syndrome was defined as hemolysis, elevated liver enzymes, and maternal platelet nadir ≤50,000 platelets/μl. Main outcome measure The primary endpoint was resolution of the HELLP syndrome as recognized by normalization of the platelet count (≥150,000/μl) and the mean length (measured in days) of the postpartum stay in hospital. Results Forty-six women with true HELLP syndrome were studied. Twenty-six patients received dexamethasone and 20 received dexamethasone plus platelet transfusion. The normalization of the platelet count was significantly more rapid in the dexamethasone group ( p < 0.004) and the postpartum hospital stay was significantly more prolonged in the dexamethasone plus platelet transfusion group ( p < 0.02). There was no maternal death. Conclusions The findings suggest the initiation of high-dose dexamethasone therapy in women with true HELLP syndrome, with the next step being delivery, and probably platelet count ≤50,000/μl alone is not always an indication for platelet transfusion.