Brief Communication Acta Haematol 2002;108:162–163 Successful Use of Recombinant Factor VIIa for Massive Bleeding after Caesarean Section due to HELLP Syndrome S. Zupanc ˇic ´S ˇ alek a V. Sokolic ´ b T. Viskovic ´ c J. S ˇ anjug c M.S ˇ imic ´ c M . Kas ˇtelan d a Haemophilia Centre, Department of Haematology, Rebro University Hospital, Zagreb, and Departments of b Anaesthesiology and Invasive Care Medicine, c Gynaecology and Obstetrics, and d Clinical Laboratory, General Hospital, Zabok, Croatia Received: January 16, 2002 Accepted: March 28, 2002 Dr. Silva Zupanc ˇic ´S ˇ alek Haemophilia Centre, Department of Haematology Rebro University Hospital, Kispaticeva street 12 CRO–10 000 Zagreb (Croatia) Tel. +385 1 2388272, Fax +385 1 3324650, E-Mail zvonko-salek@zg.tel.hr ABC Fax + 41 61 306 12 34 E-Mail karger@karger.ch www.karger.com © 2002 S. Karger AG, Basel 0001–5792/02/1083–0162$18.50/0 Accessible online at: www.karger.com/journals/aha Recombinant factor VIIa (rFVIIa) has been shown to be effective in the treatment of haemophilic patients with acquired inhibitors, patients with autoantibodies to fac- tors VIII and IX, and other congenital and acquired coa- gulopathies [1, 2]. There have been recent reports on the successful use of rFVIIa in non-haemophilic patients who have experienced heavy blood loss due to trauma with extensive organ damage and have received multiple blood transfusions with haemostatic changes without success [3]. We describe successful treatment of massive post-par- tum haemorrhage with FVIIa in a 31-year-old woman who underwent an emergency caesaran section (CS) at 38 weeks because of a deteriorating HELLP syndrome. The HELLP syndrome is named for its primary laboratory abnormalities, which are haemolysis, elevated liver en- zymes and low platelets [4]. In her first pregnancy, she developed pre-eclampsia and had a CS at 36 weeks of ges- tation. During the second pregnancy she was well until the 33rd week when she became hypertensive. During the 38th week of gestation she developed elevated liver en- zymes, significant proteinuria, and absent end-diastolic flow in the fetal umbilical arteries and aorta on Doppler ultrasound assessment. The platelet count was 60 ! 10 9 /l. She was subsequently admitted to hospital and CS was performed because of the combination of fetal distress and the HELLP syndrome. Two hours after the operation, she developed massive vaginal bleeding and also from the wound with signs of haemorrhagic shock. She was treated with replacement therapy of 12 units of packed red cells and blood, 950 IU of cryoprecipitate, 8 units of platelets and 10 units of FFP. All attempts to control the bleeding failed; the laboratory data worsened with a further fall in the platelet count. The results of the full blood count were as follows: WBC 11.6 ! 10 9 /l, RBC 1.87 ! 10 12 /l, Hb 52 g/l, Htc 0.15% and platelets 76 ! 10 9 /l. The results of coagulation tests were as follows: APTT greater than 50 s (normal range for APTT is 22–35 s), PT 32% (normal range is 70–120%), TT was prolonged with fibrinogen less than 0.1 g/l (nor- mal value is 1.8–3.5 g/l). The antithrombin level was decreased to 0.62 IU/ml (normal value is 0.7–1.2) with positive fibrin monomers. The diagnosis of disseminated intravascular coagulation (DIC) was established. In an attempt to stop the bleeding, rFVIIa in a dose of 90 Ìg/kg b.w. was administered as a bolus. Within several minutes, a significant reduction in the rate of bleeding was ob-