HELLP syndrome: Difference between revisions
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HELLP 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. | |||
__NOTOC__ | __NOTOC__ | ||
===Incidence=== | ===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=== | ||
* | *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 ). | |||
<noinclude> | <noinclude> | ||
== | ==Links == | ||
=== | ===Related Articles === | ||
* | *Hypertension in pregnancy | ||
* | * Preeclampsia | ||
* | * Eclampsia | ||
* | * Hypertension | ||
* | * Antihypertensives | ||
* | * Birth | ||
=== | ===External links === | ||
*{{Akutně|296|HELLP syndrom — interaktivní algoritmus + test}} | *{{Akutně|296|HELLP syndrom — interaktivní algoritmus + test}} | ||
===References === | |||
* BENEŠ, Jiří. ''Study materials'' [online]. [feeling. 2009]. < <nowiki>http://jirben.wz.cz</nowiki> >. | |||
< | |||
</noinclude> | </noinclude> | ||
Latest revision as of 21:46, 22 February 2023
HELLP 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[edit | edit source]
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[edit | edit source]
Unclear, probably generalized vasospasm with subsequent MODS (mainly liver , kidney ) and activation of coagulation . The result is microangiopathic thrombocytopenia .
Laboratory[edit | edit source]
- 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[edit | edit source]
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[edit | edit source]
Acute hepatic steatosis, ITP , HUS , hyperemesis gravidarum, cholecystopathy, viral hepatitis , gastroenteritis , appendicitis , pyelonephritis , renal colic , SLE .
Complications[edit | edit source]
DIC (up to 40%), placental abruption , acute respiratory insufficiency, ARDS , ascites , rupture of subcapsular hematoma of the liver, eclampsia , IUGR .
Treatment[edit | edit source]
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[edit | edit source]
Related Articles[edit | edit source]
- Hypertension in pregnancy
- Preeclampsia
- Eclampsia
- Hypertension
- Antihypertensives
- Birth
External links[edit | edit source]
References[edit | edit source]
- BENEŠ, Jiří. Study materials [online]. [feeling. 2009]. < http://jirben.wz.cz >.
