HELLP syndrome: Difference between revisions

No edit summary
No edit summary
(21 intermediate revisions by 6 users not shown)
Line 1: Line 1:
==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 pt >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
*When occurring postpartum, typically presents within 48hr of delivery
*80% of pts have no evidence of preeclampsia before delivery
*80% of patients have no evidence of preeclampsia before delivery


==Diagnosis==
==Clinical Features==
*Signs/Symptoms
*[[RUQ pain|RUQ]] or [[epigastric pain]] (40-90%)
**RUQ or epigastric pain - 40-90%
*[[Proteinuria]] (86-100%)
**Proteinuria - 86-100%
*[[Hypertension]] (82-88%)
**Hypertension - 82-88%
*Labs
**CBC w/ diff
***Microangiopathic hemolytic anemia
***Plt count <100
**LFT
***AST > 70, bilirubin > 1.2
**LDH > 600


==Work-Up==
===Complications===
#CBC
*[[Disseminated intravascular coagulation]]
##Schistocytes
*[[Acute kidney injury]]
##Thrombocytopenia
*Subcapsular liver hematoma
#LFT
*[[Hemorrhage]]
##AST, ALT elevation (although usually <500)
#Chemistry
##Normal or elevated BUN/Cr
#Coags
##Abnormal
#CT or US to check for hepatic hematoma (if needed)


==Treatment==
==Differential Diagnosis==
#Similar to that of severe preeclampsia or eclampsia
{{Postpartum emergencies DDX}}
##Magnesium
##BP control
##Coagulopathy correction
###Transfuse platelets if < 20,000 or active, uncontrolled bleeding


==Complications ==
{{Hemolytic anemia DDX}}
#DIC
 
#Acute renal failure
==Evaluation==
#Subcapsular liver hematoma
Evaluation is targeted at assessing the individual components of the syndrome. Labs to be drawn should include a:
##Abdominal distention
*CBC
##Maintain adequate intravascular volume
**May see a [[microangiopathic hemolytic anemia]] (Schistocytes on microscopy)
###If unstable consider embolization vs surgery
**[[thrombocytopenia|Platelet count <150]] × 10<sup>9</sup> per L (150 per mm<sup>3</sup>)
*Chemistry
**Normal or elevated BUN/Cr
*Coagulation panel (fibrinogen can be decreased and PTT elevated)
**Patients can progress towards [[DIC]]
*[[LFTs]]
**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)
*[[UA]] ([[proteinuria]])
*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
 
==Management==
*Similar to that of severe [[preeclampsia]] or [[eclampsia]]
**Delivery (only definitive treatment)
**[[Magnesium sulfate]]
**[[antihypertensives|BP control]]
**[[Coagulopathy (main)|Coagulopathy correction]]
***Transfuse [[platelets]] if < 20,000 or active, uncontrolled bleeding
 
==Disposition==
*Admit


==See Also==
==See Also==
*[[Post-Partum Emergencies]]
*[[Post-Partum Emergencies]]


==Source==
==References==
*Tintinalli
<references/>
*EBM, Volume 12, Number 8, Aug 2010. Postpartum Emergencies
*Uptodate


[[Category:OB/GYN]]
[[Category:OBGYN]]

Revision as of 17:40, 16 October 2019

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

Complications

Differential Diagnosis

3rd Trimester/Postpartum Emergencies

Microangiopathic Hemolytic Anemia (MAHA)

Evaluation

Evaluation is targeted at assessing the individual components of the syndrome. Labs to be drawn should include a:

  • CBC
  • Chemistry
    • Normal or elevated BUN/Cr
  • Coagulation panel (fibrinogen can be decreased and PTT elevated)
    • Patients can progress towards DIC
  • LFTs
    • 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)
  • UA (proteinuria)
  • 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

Disposition

  • Admit

See Also

References