Cascade filtration plasmapheresis for early preeclampsia: our experience
Objective. To assess the efficacy of cascade filtration plasmapheresis (CFP) for the correction of lipid profile in pregnant women with early preeclampsia. Patients and methods. We analyzed the effect of 5 CFP procedures in 4 pregnant women with preeclampsia detected at gestational age of 23(+0)-30(+4) weeks. We evaluated the dynamics of clinical manifestations of preeclampsia (blood pressure, daily diuresis, and severity of proteinuria), laboratory parameters (Р/С-ratio, lipid profile), and thromboelastometry parameters (ROTEM). We also analyzed the effect of CFP on the sFlt-1 level as it is believed to be a predictor of endothelial aggression in early preeclampsia. Treatment efficacy was assessed by prolongation of pregnancy and neonatal outcomes. Results. The inclusion of CFP in the comprehensive therapy for early preeclampsia had a positive effect on the lipid profile, in particular, it ensured a 30% decrease in the level of cholesterol, triglycerides, LDL, and VLDL, which reduced atherogenic aggression on the vascular endothelium. Moreover, CFP improved blood rheological properties by decreasing the level of fibrinogen, Willebrand factor, and structural coagulation parameters (MCF FIBTEM) according to the results of rotational thromboelastometry (ROTEM). However, we observed no significant changes in sFlt-1 levels in response to lipoprotein apheresis. All women delivered by caesarean section due to clinical and laboratory deterioration of preeclampsia. The time of pregnancy prolongation varied between 4 and 26 days. All newborns were discharged from the hospital in a satisfactory condition. Conclusion. Our experience with CFP demonstrated high effectiveness of extracorporeal therapy in correcting the lipid profile (cholesterol, triglycerides, LDL, and VLDL) and reducing atherogenic aggression on the vascular endothelium. At the same time CFP did not decrease the anti-angiogenic effect of sFlt-1. Further studies are needed to confirm our findings.