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.  
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__NOTOC__
__NOTOC__
{{Infobox - onemocnění
| česky = HELLP syndrom
| obrázek = HELLP.png
| popisek = Jak si zapamatovat HELLP
| anglicky = HELLP syndrome
| latinsky =
| rizikové faktory = preeklampsie 10−20 %<ref>{{Citace
  | typ = článek
  | příjmení1 = Haram
  | jméno1 = Kjell
  | příjmení2 = Svendsen
  | jméno2 = Einar
  | příjmení3 = Abildgaard
  | jméno3 = Ulrich
  | článek = The HELLP syndrome: clinical issues and management. A Review
  | časopis = BMC Pregnancy Childbirth
  | rok = 2009
  | svazek = 9
  | strany = 8
  | url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2654858/?tool=pubmed
  | issn = 1471-2393
}}</ref>
| patogeneze =
| klinický obraz =
| diagnostika =
| léčba =
| komplikace =
| incidence v ČR =
| prevalence v ČR =
| mortalita ve světě =
| mortalita v ČR =
| MKN = {{MKN|O10-O16|O14.2}}
| MeSH ID = {{MeSH ID|D017359}}
| OMIM = {{OMIM|614985}}
| MedlinePlus = {{MedlinePlus|000890}}
| Medscape = {{Medscape|1394126}}
}}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===
===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.
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.
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===Laboratory===
===Laboratory===
[[Soubor:Schizocyte smear 2009-12-22.JPG|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.
*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×).
* Elevation of liver tests – mainly AST (2–3×).
** Thrombocytopenia - drop below 100, consumption and destruction.
* Thrombocytopenia - drop below 100, consumption and destruction.


===Clinical picture ===
===Clinical picture ===
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===Related Articles ===
===Related Articles ===


** Hypertension in pregnancy
*Hypertension in pregnancy
** Preeclampsia
* Preeclampsia
** Eclampsia
* Eclampsia
** Hypertension
* Hypertension
** Antihypertensives
* Antihypertensives
** Birth
* Birth


===External links ===
===External links ===
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===References ===
===References ===


** BENEŠ, Jiří. ''Study materials''  [online]. [feeling. 2009]. < <nowiki>http://jirben.wz.cz</nowiki> >.
* BENEŠ, Jiří. ''Study materials''  [online]. [feeling. 2009]. < <nowiki>http://jirben.wz.cz</nowiki> >.
Category :GynecologyObstetricsEmergency medicine
 
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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 >.


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