Z Geburtshilfe Neonatol 2015; 219 - FV13_7
DOI: 10.1055/s-0035-1566536

The Freiburg Preeclampsia H.E.L.P.-Apheresis Study: rationale for lipid-apheresis in preeclampsia

C Contini 1, B König 1, F Markfeld-Erol 2, M Kunze 2, B Krumrey 1, S Zschiedrich 3, H Prömpeler 2, G Pütz 1, K Winkler 1
  • 1University Hospital Freiburg, Institute of Clinical Chemistry and Laboratory Medicine, Freiburg, Germany
  • 2University Hospital Freiburg, Department of Obstetrics and Gynecology, Freiburg, Germany
  • 3University Hospital Freiburg, Renal Division, Department of Medicine, Freiburg, Germany

Objective: During pregnancy the maternal lipid metabolism changes to meet the needs of the growing fetus, leading to an atherogenic profile. In pregnancies complicated by preeclampsia (PE) an even more atherogenic profile can be observed. H.E.L.P.-apheresis is an established method for lipoprotein removal and regeneration of endothelial function in severe hyperlipidemia. Besides lipids, 'pleiotropic effects' of H.E.L.P.-apheresis may involve the removal of inflammatory and thrombotic substances e.g. fibrinogen, IL-6, TNF-α, CRP and improvement of blood viscosity. Therefore, H.E.L.P.-apheresis is also applied when improvement of microcirculation is beneficial, e.g. in acute hearing loss or diabetic foot. Wang et al. (2006) successfully used the H.E.L.P.-technique in a first pilot study to prolong preeclamptic pregnancies by apheresis. We aimed to investigate the alterations in the lipid profile and the effects of H.E.L.P.-apheresis in the prolongation of pregnancies complicated by PE.

Methods: Eight patients with early pregnancy (24 + 4 to 30 + 0) complicated by PE were treated with H.E.L.P.-apheresis. Treatments were planned individually according to the clinical condition of the patient. Blood for analysis was collected before and following apheresis.

Results: A total of 25 apheresis treatments (1 – 6 per patient) were performed without severe complications. ApoB-containing lipoproteins were removed as expected, leading to a reduction of triglycerides (-42%) and cholesterol (-33%). Within ApoB-containing lipoproteins, very-low-density lipoproteins and small-dense lipoproteins were removed at highest proportion. Fibrinogen decreased by 56% and plasma/serum viscosity was reduced by 9%. Soluble fms-like tyrosine kinase-1 (sFlt-1) was not removed.

Conclusion: Pregnancies continued in average for 8 days (0 – 14) after the first apheresis treatment and lung maturation was successfully initiated before caesarean section. All children could be discharged in healthy condition.