HELLP syndrome: Difference between revisions
m (Rossdonaldson1 moved page HELLP Syndrome to HELLP syndrome) |
No edit summary |
||
| Line 22: | Line 22: | ||
#CBC | #CBC | ||
##Schistocytes | ##Schistocytes | ||
##Thrombocytopenia | ##[[Thrombocytopenia]] | ||
#LFT | #LFT | ||
##AST, ALT elevation (although usually <500) | ##AST, ALT elevation (although usually <500) | ||
| Line 30: | Line 30: | ||
##Abnormal | ##Abnormal | ||
#CT or US to check for hepatic hematoma (if needed) | #CT or US to check for hepatic hematoma (if needed) | ||
==Differential Diagnosis== | |||
{{Postpartum emergencies DDX}} | |||
==Treatment== | ==Treatment== | ||
#Similar to that of severe preeclampsia or eclampsia | #Similar to that of severe [[preeclampsia]] or [[eclampsia]] | ||
##Magnesium | ##[[Magnesium]] | ||
##BP control | ##BP control | ||
##Coagulopathy correction | ##[[Coagulopathy correction]] | ||
###Transfuse platelets if < 20,000 or active, uncontrolled bleeding | ###Transfuse [[platelets]] if < 20,000 or active, uncontrolled bleeding | ||
==Complications == | ==Complications == | ||
Revision as of 17:12, 10 January 2015
Background
- HELLP = Hemolysis, Elevated LFTS, Low Platelets
- Clinical variant of preeclampsia
- Any pt >20wk gestation or <4wk postpartum c/o abd pain should receive HELLP w/u
- Usually presents w/in 48 hr of delivery
- 80% of pts have no evidence of preeclampsia before delivery
Diagnosis
- Signs/Symptoms
- RUQ or epigastric pain - 40-90%
- Proteinuria - 86-100%
- Hypertension - 82-88%
- Labs
- CBC w/ diff
- Microangiopathic hemolytic anemia
- Plt count <100
- LFT
- AST > 70, bilirubin > 1.2
- LDH > 600
- CBC w/ diff
Work-Up
- CBC
- Schistocytes
- Thrombocytopenia
- LFT
- AST, ALT elevation (although usually <500)
- Chemistry
- Normal or elevated BUN/Cr
- Coags
- Abnormal
- CT or US to check for hepatic hematoma (if needed)
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
Treatment
- Similar to that of severe preeclampsia or eclampsia
- Magnesium
- BP control
- Coagulopathy correction
- Transfuse platelets if < 20,000 or active, uncontrolled bleeding
Complications
- DIC
- Acute renal failure
- Subcapsular liver hematoma
- Abdominal distention
- Maintain adequate intravascular volume
- If unstable consider embolization vs surgery
See Also
Source
- Tintinalli
- EBM, Volume 12, Number 8, Aug 2010. Postpartum Emergencies
- Uptodate