HELLP syndrome: Difference between revisions

Revision as of 13:02, 22 February 2023

Template:Infobox - onemocněníHELLP syndrome is a very serious complication of pregnancy with significant mortality and morbidity (up to 40%). The name originated from the English words Hemolysis, Elevated Liver enzymes, Low Platelets . It is described either as a separate disease or as a complication of preeclampsia . It is a state of severe preeclampsia complicated by hemolysis , thrombocytopenia , abnormal peripheral blood smear, and abnormal liver function tests .

Incidence

In 2-12% of preeclampsia, most often in multiparous couples around the age of 25, most often in the 36th week, in 70% before delivery, in 30% after delivery.

Pathogenesis

Unclear, probably generalized vasospasm with subsequent MODS (mainly liver , kidney ) and activation of coagulation . The result is microangiopathic thrombocytopenia .

Laboratory

thumb|right|Schistocyt

- Hemolysis – pathological smear of blood – there are schistocytes and burr cells (triangular erythrocytes ) – probably formed by flow through the affected vessel, rise of bilirubin above 20 μmol/l, LD (5×), free iron in the serum.
- Elevation of liver tests – mainly AST (2–3×).
- Thrombocytopenia - drop below 100, consumption and destruction.

Clinical picture

Pain in the epigastrium and in the right hypochondrium , nausea and vomiting dominate . Prodromes – non-specific, flu-like (malaise, fatigue). The advanced stage is manifested by bleeding ( hematuria , bleeding into the GIT ). Weight gain with swelling , hypertension with proteinuria , sometimes jaundice . A fully developed HELLP mimics DIC .

Differential diagnosis

Acute hepatic steatosis, ITP , HUS , hyperemesis gravidarum, cholecystopathy, viral hepatitis , gastroenteritis , appendicitis , pyelonephritis , renal colic , SLE .

Complications

DIC (up to 40%), placental abruption , acute respiratory insufficiency, ARDS , ascites , rupture of subcapsular hematoma of the liver, eclampsia , IUGR .

Treatment

Termination of pregnancy is the only causal treatment. Conservative therapy is for the postpartum period. Expansion of plasma volume, adjustment of coagulation ( antithrombin III , plasma , erymasa, platelets), corticoids (immunosuppression), anticonvulsant prophylaxis (MgSO 4 , valium), antihypertensives , ATB , diet, hepatoprotectants , plasmapheresis ( dialysis ).

Links

External links

Template:Akutně

References

- BENEŠ, Jiří. Study materials [online]. [feeling. 2009]. < http://jirben.wz.cz >.

Category :GynecologyObstetricsEmergency medicine

@@ Line 63: / Line 63: @@
 ** Thrombocytopenia - drop below 100, consumption and destruction.
-===Klinický obraz===
+===Clinical picture ===
-Dominuje '''[[bolest]] v epigastriu a v pravém podžebří''', [[nauzea]] a [[zvracení]]. Prodromy – nespecifické, chřipkovité (malátnost, únava).
+Pain in the epigastrium and in the right hypochondrium , nausea and vomiting dominate . Prodromes – non-specific, flu-like (malaise, fatigue). The advanced stage is manifested by bleeding ( hematuria , bleeding into the GIT ). Weight gain with swelling , hypertension with proteinuria , sometimes jaundice . A fully developed HELLP mimics DIC .
-Pokročilé stádium se projevuje krvácením ([[hematurie]], [[Krvácení z trávicí trubice|krvácení do GIT]]). Hmotnostní přírůstek s [[otok]]y, [[Arteriální hypertenze|hypertenze]] s [[proteinurie|proteinurií]], někdy [[ikterus]]. Plně rozvinutý HELLP imituje [[Diseminovaná intravaskulární koagulace|DIC]].
-===Diferenciální diagnostika===
+===Differential diagnosis===
-Akutní steatóza jater, [[Idiopatická trombocytopenická purpura|ITP]], [[Hemolyticko-uremický syndrom|HUS]], hyperemesis gravidarum, cholecystopatie, [[virové hepatitidy|virová hepatitida]], [[Průjmová onemocnění|gastroenteritida]], [[apendicitida v těhotenství|apendicitida]], [[Infekce močových cest|pyelonefritida]], [[renální kolika]], [[Systémový lupus erythematodes|SLE]].
+Acute hepatic steatosis, ITP , HUS , hyperemesis gravidarum, cholecystopathy, viral hepatitis , gastroenteritis , appendicitis , pyelonephritis , renal colic , SLE .
-===Komplikace===
+===Complications ===
-[[DIC]] (až u 40 %), abrupce [[placenta|placenty]], akutní respirační insuficience, [[Syndrom akutní dechové tísně|ARDS]], [[ascites]], ruptura subkapsulárního hematomu jater, [[eklampsie]], [[Intrauterinní růstová retardace|IUGR]].
+DIC (up to 40%), placental abruption , acute respiratory insufficiency, ARDS , ascites , rupture of subcapsular hematoma of the liver, eclampsia , IUGR .
-===Léčba===
+===Treatment===
-'''Ukončení gravidity''' je jedinou kauzální léčbou.<ref>{{Citace| typ = kniha| isbn = 9781416056829| příjmení1 = Smith| jméno1 = Roger P| příjmení2 = Machado| jméno2 = Carlos A. G | titul = Netter&rsquo;s obstetrics and gynecology| vydání = 2| místo = Philadelphia| vydavatel = Saunders/Elsevier| rok = 2008| strany = 525}}</ref>
+Termination of pregnancy is the only causal treatment.  Conservative therapy is for the postpartum period. Expansion of plasma volume, adjustment of coagulation ( antithrombin III , plasma , erymasa, platelets), corticoids (immunosuppression), anticonvulsant prophylaxis (MgSO 4 , valium), antihypertensives , ATB , diet, hepatoprotectants , plasmapheresis ( dialysis ).
-Konzervativní terapie je pro poporodní období. Expanze plasmatického volumu, úprava koagulace ([[antitrombin III]], [[Krevní plazma|plasma]], erymasa, trombocyty), [[Glukokortikoidy|kortikoidy]] (imunosuprese), protikřečová profylaxe (MgSO<sub>4</sub>, valium), [[antihypertenziva]], [[Antibiotika|ATB]], dieta, [[hepatoprotektiva]], plasmaferéza ([[hemodialýza|dialýza]]).
 <noinclude>
-==Odkazy==
+==Links ==
-===Související články===
+===Related Articles ===
-*[[Hypertenze v těhotenství]]
+** Hypertension in pregnancy
-*[[Preeklampsie]]
+** Preeclampsia
-*[[Eklampsie]]
+** Eclampsia
-*[[Hypertenze]]
+** Hypertension
-*[[Antihypertenziva]]
+** Antihypertensives
-*[[Porod]]
+** Birth
-===Externí odkazy===
+===External links ===
 *{{Akutně|296|HELLP syndrom — interaktivní algoritmus + test}}
+===References ===
-===Reference===
+** BENEŠ, Jiří. ''Study materials''  [online]. [feeling. 2009]. < <nowiki>http://jirben.wz.cz</nowiki> >.
-<references />
+Category :GynecologyObstetricsEmergency medicine
-===Použitá literatura===
-* {{Citace
-|typ = web
-|příjmení1 = Beneš
-|jméno1 = Jiří
-|název = Studijní materiály
-|rok =
-|citováno = 2009
-|url = http://jirben.wz.cz
-}}
-[[Kategorie:Vložené články]]
-[[Kategorie:Gynekologie]]
-[[Kategorie:Porodnictví]]
-[[Kategorie:Neodkladná medicína]]
 </noinclude>