Abstract
OBJECTIVE: HELLP syndrome is a life-threatening obstetric complication marked by microangiopathic hemolytic anemia, elevated liver enzymes, and thrombocytopenia and potentially affecting multiple organ systems. While definitive treatment is typically achieved through delivery, in rare instances, both clinical and laboratory parameters may worsen in the postpartum period. In such critical cases, therapeutic plasma exchange (TPE) can serve as a potentially life-saving intervention. METHODS: This study analyzed the laboratory and clinical responses of 21 patients diagnosed with severe HELLP syndrome who underwent postpartum TPE between 2010 and 2023. RESULTS: Of the 21 patients, 14 (66.7%) were categorized as class 1 HELLP syndrome, and 7 (33.3%) as class 2. TPE was administered in a single session for 8 patients (38.1%), in two sessions for another 8 (38.1%), and in three sessions for the remaining 5 (23.8%). A significant increase in platelet count and significant decreases in lactate dehydrogenase (LDH), international normalized ratio (INR), activated partial thromboplastin time (APTT), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and bilirubin levels were observed when compared before and after TPE. Despite intervention, severe complications—including sepsis, pulmonary edema, renal failure, cerebrovascular events, and disseminated intravascular coagulation (DIC)—developed in 9 patients (42.8%). One patient (4.8%) died due to multiorgan failure. CONCLUSION: These findings suggest that TPE administered in the postpartum period can significantly improve clinical outcomes, hematological and biochemical derangements in patients with severe HELLP syndrome. Early initiation of TPE, ideally within 24–48 h following delivery in patients unresponsive to supportive care, is strongly recommended. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12884-025-08585-x.