Gökçe GİŞİ, Selma GÜLER, Mahmut ARSLAN, Birsen DOĞU, Cengizhan YAVUZ, Şeyma BAHAR, Arzu UYGUNGELEN, Hafize ÖKSÜZ

HELLP Syndrome with Long-Lasting Severe Sepsis: A Case Report

Preeklampsi; hipertansiyon ve proteinuri ile karakterize, gebeliğin ikinci yarısından sonra görülen bir hastalıktır. Tüm dünyada gebelerin %5 ile %7'sini etkileyen, maternal ile fetal mortalite ve morbiditenin birinci nedenidir. HELLP sendromu (Hemolysis-Elevated Liver enzymes-Low Platelets) ise preeklamtik gebelerin yaklaşık %4-20'sinde görülen, yüksek maternal ve perinatal morbidite ve mortalite ile ilişkili bir tablodur. HELLP sendromlu hastalarda akut sıkıntılı solunum sendromu (ARDS), intraserebral kanama, akut böbrek yetersizliği (ABY), hepatik rüptür, yaygın damar içi pıhtılaşma bozukluğu (YDİPB) ve septik şok gibi komplikasyonlar maternal morbidite ve mortalite artması nedeniyle yoğun bakım ihtiyacı ortaya çıkabilmektedir. Sezeryan sonrası postoperatif dönemde yoğun bakım ünitesinde takip ettiğimiz ve uzun süren ciddi sepsis nedeniyle tedavi ettiğimiz HELLP sendromlu bir hastanın sunulması amaçlanmıştır.

HELLP Sendromu Olan Hastada Uzun Süren Ciddi Sepsis: Bir Olgu Sunumu

Preeclampsia is a disease manifesting itself in the second half of pregnancy, and characterised by hypertension and proteinuria. It affects 5% to 7% of pregnant women all over the world making it the most common cause of maternal and fetal morbidity and mortality. HELLP syndrome (Hemolysis-Elevated Liver enzymes-Low Platelets) occurs in about 4%-20% of the preeclamptic pregnant women and it is often associated with high maternal and perinatal morbidity and mortality rates. HELLP syndrome may require monitoring in the intensive care unit because of the increased morbidity and mortality rates it brings about as a result of potential complications such as acute respiratory distress syndrome (ARDS), intracerebral hemorrhage, acute renal failure, hepatic rupture, disseminated intravascular coagulation, and septic shock. We aim to present the case story of a long-lasting but successful postoperative treatment for severe sepsis of a patient with HELLP syndrome who was monitored in our intensive care unit after a caesarean section.

PDF

___

Kvehaugen AS, Dechen R, Ramstad HB, et. al. Endothelial Function and Circulating Biomarkers are Disturbed in Women and Children After Preeclampsia. Hypertension.2011; 58:63-9.
Lain KY, Roberts JM. Contemporary concepts of the pathogenesis and management of preeclampsia. J Am Med Assoc 2002;287:3183-6.
Borzychowski AM, Sargent IL, Redman CW. Inflammation and pre-eclampsia. Semin Fetal Neonatal Med 2006;11: 309-16.
Yosunkaya A, Keçecioğlu A, Erdem TB, Borazan H.Yoğun Bakım Ünitemizde Sık Rastlanan Obstetrik Sorun: Hellp Sendromu (15 Olgunun Analizi. Selçuk Tıp Üniv. Derg 2011; 27(1):18-23.
Baxter JK, Weinstein L. HELLP syndrome: the state of the art. Obstet Gynecol Surv 2004, 59:838-45.
Haram K, Svendsen E, Abildgaard U. The HELLP syndrome: Clinical issues and management. BMC Pregnancy and Childbirth 2009, 9:8-23.
Sibai BM. Diagnosis, controversies, and management of the syndrome of hemolysis, elevated liver enzymes, and low platelet count. Obstet Gynecol 2004, 103:981-91.
Eser B, Güven M, Ünal A, Coşkun R, Altuntaş F, et al. The role of plasma exchange in HELLP Syndrome. Clin Appl Thrombosis/Hemostasis. 2005; 11(2):211-7.
Sibai BM, Ramadan MK, Usta I, Salama M, Mercer BM, Friedman SA. Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes, and low platelets (HELLPsyndrome). Am J Obstet Gynecol 1993, 169:1000-6.
Montagnana M, Lippi G, Albiero A, et al. Procalcitonin values in preeclamptic women are releated to severity of disease. Clin Chem Lab Med 2008; 46(7): 1050-1.
Acosta CD, Knight M, Lee HC, et. al. The Continuum of Maternal Sepsis Severity: Incedence and Risk Factors in a Population -Based Cohort Study. PLoS One. 2013; 83(7)e67175.www.plosone.org.
John R, Barton MD, and Baha M.Sibai MD. Severe sepsis and septic shock in pregnancy: Clinical expert studys. 2012; 120 (3).