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2016 ; 44
(5
): 390-8
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Direct evidence of complement activation in HELLP syndrome: A link to atypical
hemolytic uremic syndrome
#MMPMID26921648
Vaught AJ
; Gavriilaki E
; Hueppchen N
; Blakemore K
; Yuan X
; Seifert SM
; York S
; Brodsky RA
Exp Hematol
2016[May]; 44
(5
): 390-8
PMID26921648
show ga
HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) is a severe
variant of pre-eclampsia whose pathogenesis remains unclear. Recent evidence and
clinical similarities suggest a link to atypical hemolytic uremic syndrome, a
disease of excessive activation of the alternative complement pathway effectively
treated with a complement inhibitor, eculizumab. Therefore, we used a functional
complement assay, the modified Ham test, to analyze sera of women with classic or
atypical HELLP syndrome, pre-eclampsia with severe features, normal pregnancies,
and healthy nonpregnant women. Sera were also evaluated using levels of the
terminal product of complement activation (C5b-9). We tested the in vitro ability
of eculizumab to inhibit complement activation in HELLP serum. Increased
complement activation was observed in participants with classic or atypical HELLP
compared with those with normal pregnancies and nonpregnant controls. Mixing
HELLP serum with eculizumab-containing serum resulted in a significant decrease
in cell killing compared with HELLP serum alone. We found that HELLP syndrome is
associated with increased complement activation as assessed with the modified Ham
test. This assay may aid in the diagnosis of HELLP syndrome and could confirm
that its pathophysiology is related to that of atypical hemolytic uremic
syndrome.