HELLP syndrome - Revision history

Rossdonaldson1: /* Differential Diagnosis */

2021-11-25T13:33:22Z

Differential Diagnosis

← Older revision		Revision as of 13:33, 25 November 2021
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	==Differential Diagnosis==		==Differential Diagnosis==
	{{Postpartum emergencies DDX}}		{{Postpartum emergencies DDX}}

	{{Hemolytic anemia DDX}}		{{Hemolytic anemia DDX}}
			{{Jaundice DDX}}

	==Evaluation==		==Evaluation==

ClaireLewis at 17:40, 16 October 2019

2019-10-16T17:40:27Z

← Older revision		Revision as of 17:40, 16 October 2019
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	==Clinical Features==		==Clinical Features==
	*[[RUQ pain\|RUQ]] or [[epigastric pain]] (40-90%)		*[[RUQ pain\|RUQ]] or [[epigastric pain]] (40-90%)
	*Proteinuria (86-100%)		*[[Proteinuria]] (86-100%)
	*[[Hypertension]] (82-88%)		*[[Hypertension]] (82-88%)

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	**AST levels > 150 IU/L and ALT levels > 100 IU/L (also often associated with bilirubin > 1.2mg/dL		**AST levels > 150 IU/L and ALT levels > 100 IU/L (also often associated with bilirubin > 1.2mg/dL
	**LDH elevation (often > 600 IU/L)		**LDH elevation (often > 600 IU/L)
			*[[UA]] ([[proteinuria]])
	*CT or [[Ultrasound (main)\|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

ClaireLewis at 19:35, 3 October 2019

2019-10-03T19:35:39Z

← Older revision		Revision as of 19:35, 3 October 2019
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	==Background==		==Background==
	*HELLP = Hemolysis, Elevated LFTs, Low Platelets		*HELLP = [[hemolytic anemia\|Hemolysis]], Elevated [[LFTs]], [[thrombocytopenia\|Low Platelets]]
	*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
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	==Clinical Features==		==Clinical Features==
	*RUQ or epigastric pain (40-90%)		*[[RUQ pain\|RUQ]] or [[epigastric pain]] (40-90%)
	*Proteinuria (86-100%)		*Proteinuria (86-100%)
	*Hypertension (82-88%)		*[[Hypertension]] (82-88%)

			===Complications===
			*[[Disseminated intravascular coagulation]]
			*[[Acute kidney injury]]
			*Subcapsular liver hematoma
			*[[Hemorrhage]]

	==Differential Diagnosis==		==Differential Diagnosis==
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	*CBC		*CBC
	**May see a [[microangiopathic hemolytic anemia]] (Schistocytes on microscopy)		**May see a [[microangiopathic hemolytic anemia]] (Schistocytes on microscopy)
	**Platelet count <150 × 10<sup>9</sup> per L (150 per mm<sup>3</sup>)		**[[thrombocytopenia\|Platelet count <150]] × 10<sup>9</sup> per L (150 per mm<sup>3</sup>)
	*Chemistry		*Chemistry
	**Normal or elevated BUN/Cr		**Normal or elevated BUN/Cr
	*Coagulation panel (fibrinogen can be decreased and PTT elevated)		*Coagulation panel (fibrinogen can be decreased and PTT elevated)
	**Patients can progress towards [[DIC]]		**Patients can progress towards [[DIC]]
	*~~LFT~~		*[[LFTs]]
	**AST levels > 150 IU/L and ALT levels > 100 IU/L (also often associated with bilirubin > 1.2mg/dL		**AST levels > 150 IU/L and ALT levels > 100 IU/L (also often associated with bilirubin > 1.2mg/dL
	**LDH elevation (often > 600 IU/L)		**LDH elevation (often > 600 IU/L)
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	**Delivery (only definitive treatment)		**Delivery (only definitive treatment)
	**[[Magnesium sulfate]]		**[[Magnesium sulfate]]
	**BP control		**[[antihypertensives\|BP control]]
	**[[Coagulopathy (main)\|Coagulopathy correction]]		**[[Coagulopathy (main)\|Coagulopathy correction]]
	***Transfuse [[platelets]] if < 20,000 or active, uncontrolled bleeding		***Transfuse [[platelets]] if < 20,000 or active, uncontrolled bleeding
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	==Disposition==		==Disposition==
	*Admit		*Admit

	~~==Complications==~~
	*[[Disseminated intravascular coagulation]]
	*[[Acute kidney injury]]
	*Subcapsular liver hematoma
	*Hemorrhage

	==See Also==		==See Also==

Ostermayer: /* Evaluation */

2019-05-17T03:09:39Z

Evaluation

← Older revision		Revision as of 03:09, 17 May 2019
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	*CBC		*CBC
	**May see a [[microangiopathic hemolytic anemia]] (Schistocytes on microscopy)		**May see a [[microangiopathic hemolytic anemia]] (Schistocytes on microscopy)
	**Platelet count <~~100~~/µL		**Platelet count <150 × 10<sup>9</sup> per L (150 per mm<sup>3</sup>)
	*Chemistry		*Chemistry
	**Normal or elevated BUN/Cr		**Normal or elevated BUN/Cr

Ostermayer: /* Evaluation */

2019-05-17T03:07:20Z

Evaluation

← Older revision		Revision as of 03:07, 17 May 2019
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	*Chemistry		*Chemistry
	**Normal or elevated BUN/Cr		**Normal or elevated BUN/Cr
	*Coagulation panel		*Coagulation panel (fibrinogen can be decreased and PTT elevated)
	**~~Abnormalities only if there is component of~~ [[DIC]]		**Patients can progress towards [[DIC]]
	*LFT		*LFT
	**AST > ~~70 U~~/L, bilirubin > 1.2mg/dL		**AST levels > 150 IU/L and ALT levels > 100 IU/L (also often associated with bilirubin > 1.2mg/dL
	**~~ALT~~ elevation (~~although usually <500)~~		**LDH elevation (often > 600 IU/L)
	*LDH > 600 IU/L
	*CT or [[Ultrasound (main)\|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

Mholtz at 04:56, 15 February 2017

2017-02-15T04:56:32Z

← Older revision		Revision as of 04:56, 15 February 2017
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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
	*~~Usually~~ presents within ~~48 hr~~ of delivery		*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 - 40-90%		*RUQ or epigastric pain (40-90%)
	*Proteinuria - 86-100%		*Proteinuria (86-100%)
	*Hypertension - 82-88%		*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==
	*[[~~DIC~~]]		*[[Disseminated intravascular coagulation]]
	*[[Acute ~~renal failure~~]]		*[[Acute kidney injury]]
	*Subcapsular liver hematoma		*Subcapsular liver hematoma
	*Hemorrhage		*Hemorrhage
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	==References==		==References==
	*EBM, Volume 12, Number 8, Aug 2010. Postpartum Emergencies		<references/>

	[[Category:OBGYN]]		[[Category:OBGYN]]

Rossdonaldson1: Text replacement - " US " to " ultrasound "

2016-11-13T21:45:38Z

Text replacement - " US " to " ultrasound "

← Older revision		Revision as of 21:45, 13 November 2016
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	**ALT elevation (although usually <500)		**ALT elevation (although usually <500)
	*LDH > 600 IU/L		*LDH > 600 IU/L
	*CT or US can be considered if there is pain requiring a greater workup.		*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		**Depending on degree of [[thrombocytopenia]] are at risk for developing intraabdominal bleeding such as a hepatic hematoma

Neil.m.young: Text replacement - "2 mg" to "2mg"

2016-07-19T12:19:58Z

Text replacement - "2 mg" to "2mg"

← Older revision		Revision as of 12:19, 19 July 2016
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	**Abnormalities only if there is component of [[DIC]]		**Abnormalities only if there is component of [[DIC]]
	*LFT		*LFT
	**AST > 70 U/L, bilirubin > 1.~~2 mg~~/dL		**AST > 70 U/L, bilirubin > 1.2mg/dL
	**ALT elevation (although usually <500)		**ALT elevation (although usually <500)
	*LDH > 600 IU/L		*LDH > 600 IU/L

ClaireLewis: /* Evaluation */

2016-07-12T23:57:11Z

Evaluation

← Older revision		Revision as of 23:57, 12 July 2016
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	Evaluation is targeted at assessing the individual components of the syndrome. Labs to be drawn should include a:		Evaluation is targeted at assessing the individual components of the syndrome. Labs to be drawn should include a:
	*CBC		*CBC
	**May see a microangiopathic hemolytic anemia (Schistocytes on microscopy)		**May see a [[microangiopathic hemolytic anemia]] (Schistocytes on microscopy)
	**Platelet count <100/µL		**Platelet count <100/µL
	*Chemistry		*Chemistry
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	*LDH > 600 IU/L		*LDH > 600 IU/L
	*CT or US can be considered if there is pain requiring a greater workup.		*CT or US can be considered if there is pain requiring a greater workup.
	**~~Patients depending~~ on degree of thrombocytopenia are at risk ~~of developming~~ intraabdominal bleeding such as a hepatic hematoma		**Depending on degree of [[thrombocytopenia]] are at risk for developing intraabdominal bleeding such as a hepatic hematoma

	==Management==		==Management==

ClaireLewis: /* Background */

2016-07-12T23:55:39Z

Background

← Older revision		Revision as of 23:55, 12 July 2016
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	==Background==		==Background==
	*HELLP = Hemolysis, Elevated ~~LFTS~~, Low Platelets		*HELLP = Hemolysis, Elevated LFTs, Low Platelets
	*Clinical variant of preeclampsia		*Clinical variant of [[preeclampsia]]
	*Any patient >20wk gestation or <4wk postpartum ~~c/o abd~~ pain should receive HELLP ~~w/u~~		*Any patient >20wk gestation or <4wk postpartum complaining of abdominal pain should receive HELLP workup
	*Usually presents ~~w/in~~ 48 hr of delivery		*Usually presents within 48 hr of delivery
	*80% of patients have no evidence of preeclampsia before delivery		*80% of patients have no evidence of preeclampsia before delivery