HELLP syndrome: Difference between revisions
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*Clinical variant of [[preeclampsia]] | *Clinical variant of [[preeclampsia]] | ||
*Any patient >20wk gestation or <4wk postpartum complaining of abdominal pain should receive HELLP workup | *Any patient >20wk gestation or <4wk postpartum complaining of abdominal pain should receive HELLP workup | ||
* | *When occurring postpartum, typically presents within 48hr of delivery | ||
*80% of patients have no evidence of preeclampsia before delivery | *80% of patients have no evidence of preeclampsia before delivery | ||
==Clinical Features== | ==Clinical Features== | ||
*RUQ or epigastric pain | *RUQ or epigastric pain (40-90%) | ||
*Proteinuria | *Proteinuria (86-100%) | ||
*Hypertension | *Hypertension (82-88%) | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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**ALT elevation (although usually <500) | **ALT elevation (although usually <500) | ||
*LDH > 600 IU/L | *LDH > 600 IU/L | ||
*CT or [[ultrasound]] can be considered if there is pain requiring a greater workup. | *CT or [[Ultrasound (main)|ultrasound]] can be considered if there is pain requiring a greater workup. | ||
**Depending on degree of [[thrombocytopenia]] are at risk for developing intraabdominal bleeding such as a hepatic hematoma | **Depending on degree of [[thrombocytopenia]] are at risk for developing intraabdominal bleeding such as a hepatic hematoma | ||
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*Similar to that of severe [[preeclampsia]] or [[eclampsia]] | *Similar to that of severe [[preeclampsia]] or [[eclampsia]] | ||
**Delivery (only definitive treatment) | **Delivery (only definitive treatment) | ||
**[[Magnesium]] | **[[Magnesium sulfate]] | ||
**BP control | **BP control | ||
**[[Coagulopathy correction]] | **[[Coagulopathy (main)|Coagulopathy correction]] | ||
***Transfuse [[platelets]] if < 20,000 or active, uncontrolled bleeding | ***Transfuse [[platelets]] if < 20,000 or active, uncontrolled bleeding | ||
==Disposition== | |||
*Admit | |||
==Complications== | ==Complications== | ||
*[[ | *[[Disseminated intravascular coagulation]] | ||
*[[Acute | *[[Acute kidney injury]] | ||
*Subcapsular liver hematoma | *Subcapsular liver hematoma | ||
*Hemorrhage | *Hemorrhage | ||
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==References== | ==References== | ||
<references/> | |||
[[Category:OBGYN]] | [[Category:OBGYN]] | ||
Revision as of 04:56, 15 February 2017
Background
- HELLP = Hemolysis, Elevated LFTs, Low Platelets
- Clinical variant of preeclampsia
- Any patient >20wk gestation or <4wk postpartum complaining of abdominal pain should receive HELLP workup
- When occurring postpartum, typically presents within 48hr of delivery
- 80% of patients have no evidence of preeclampsia before delivery
Clinical Features
- RUQ or epigastric pain (40-90%)
- Proteinuria (86-100%)
- Hypertension (82-88%)
Differential Diagnosis
3rd Trimester/Postpartum Emergencies
- Acute fatty liver of pregnancy
- Amniotic fluid embolus
- Chorioamnionitis
- Eclampsia
- HELLP syndrome
- Mastitis
- Peripartum cardiomyopathy
- Postpartum endometritis (postpartum PID)
- Postpartum headache
- Postpartum hemorrhage
- Preeclampsia
- Resuscitative hysterotomy
- Retained products of conception
- Septic abortion
- Uterine rupture
Microangiopathic Hemolytic Anemia (MAHA)
- Disseminated Intravascular Coagulation (DIC)
- Thrombotic Thrombocytopenic Purpura (TTP)
- Hemolytic Uremic Syndrome (HUS)
- HELLP syndrome
- Heparin-Induced Thrombocytopenia (HIT)
- Hereditary spherocytosis
- Paroxysmal nocturnal hemoglobinuria (PNH)
- Malignant hypertension
- Scleroderma
- Antiphospholipid Syndrome (APS)
- Other medical causes: malignancy, renal allograft rejection, vasculitides like polyarteritis nodosa and Wegener's granulomatosis
- Drugs: chemotherapy; Clopidogrel (Plavix) associated with TTP
- Nonvascular causes: prosthetic valve (more common with mechanical, more common at aortic valve), LVAD, TIPS, coil embolization, patched AV shunt, AVM
Evaluation
Evaluation is targeted at assessing the individual components of the syndrome. Labs to be drawn should include a:
- CBC
- May see a microangiopathic hemolytic anemia (Schistocytes on microscopy)
- Platelet count <100/µL
- Chemistry
- Normal or elevated BUN/Cr
- Coagulation panel
- Abnormalities only if there is component of DIC
- LFT
- AST > 70 U/L, bilirubin > 1.2mg/dL
- ALT elevation (although usually <500)
- LDH > 600 IU/L
- CT or ultrasound can be considered if there is pain requiring a greater workup.
- Depending on degree of thrombocytopenia are at risk for developing intraabdominal bleeding such as a hepatic hematoma
Management
- Similar to that of severe preeclampsia or eclampsia
- Delivery (only definitive treatment)
- Magnesium sulfate
- BP control
- Coagulopathy correction
- Transfuse platelets if < 20,000 or active, uncontrolled bleeding
Disposition
- Admit
Complications
- Disseminated intravascular coagulation
- Acute kidney injury
- Subcapsular liver hematoma
- Hemorrhage