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Management Of A Case Of HELLP Syndrome Complicated With Severe Preeclampsia And Immune Thrombocytopenia

Year 2015, Volume: 10 Issue: 3, 0 - 0, 14.10.2016

Fazil Avcı Murat Bakacak Salih Serin Bülent Köstü Önder Ercan

Abstract

HELLP syndrome is a life- threatening form of pre-eclampsia.  In this study we present a case of HELLP syndrome which was complicated with severe pre-eclampsia and immune thrombocytopenia. A 38-year-old pregnant woman with HELLP syndrome at 39 2/7 weeks of gestation was admitted to our clinic with vomiting and nausea. In this case, laboratory findings which were associated with HELLP syndrome were found to include haemolysis, elevated liver enzymes and low platelet counts. In additon, she had severe pre-eclampsia with hypertension and 3+ protein in urine. After the necessary medical agents were administered, a caesarean section was performed due to her clinic status and fetal distress. By the 7th day, the clinical course and laboratory values of the patient normalized within supportive steroid treatment. Early diagnosis and treatment of HELLP syndrome may  prevent maternal and perinatal mortality and morbidity.

References

  • Sibai BM: The HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets): much ado about nothing? Am J Obstet Gynecol 1990, 162:311–316.
  • Sibai BM. Diagnosis, controversies, and management of the syndrome of hemolysis, elevated liver enzymes, and low platelet count. Obstet Gynecol. 2004;103(5Pt1):981–9.
  • Sullivan CA, Martin JN Jr. Management of the obstetric patient with thrombocytopenia. Clin Obstet Gynecol. 1995;38(3):521-534.
  • Burrows RF, Kelton JG. Fetal thrombocytopenia and its relation to maternal thrombocytopenia. N Engl J Med. 1993;329(20):1463-1466.
  • Geary M: The HELLP syndrome. Br J Obstet Gynaecol 1997, 104:887-891.
  • Karumanchi SA, Maynard SE, Stillman IE, Epstein FH, Sukhatme VP. Preeclampsia: a renal perspective. Kidney Int 2005,67:2101-2113.
  • Sibai BM, Ramadan MK, Usta I, Salama M, Mercer BM, Friedman SA. Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver nzymes, and low platelets (HELLP syndrome). Am J Obstet Gynecol 1993, 169:1000-1006.
  • Magann EF, Martin JN Jr. Twelve steps to optimal management of HELLP syndrome. Clin Obstet Gynecol 1999, 42:532-550.
  • Barton JR, Sibai BM. Diagnosis and management of hemolysis, elevated liver enzymes, and low platelets syndrome. Clin Perinatol 2004, 31:807-33.
  • Martin JN Jr, Rose CH, Briery CM. Understanding and managing HELLP syndrome: the integral role of aggressive glucocorticoids for mother and child. Am J Obstet Gynecol 2006, 195:914-934.
  • Sibai BM: Diagnosis, controversies, and management of the syndrome of hemolysis, elevated liver enzymes, and low platelet count. Obstet Gynecol 2004, 103:981-991.
  • JG, Houthoff HJ, Weits J, Vellenga E, Huisjes HJ. A syndrome of liver damage and intravascular coagulation in the last trimester of normotensive pregnancy. A clinical and histopathological study. Br J Obstet Gynaecol 1986, 93:145-155.
  • Ertan AK, Wagner S, Hendrik HJ, Tanriverdi HA, Schmidt W. Clinical and biophysical aspects of HELLP-syndrome. J Perinat Med 2002, 30:483-489.
  • Magann EF, Bass D, Chauhan SP, Sullivan DL, Martin RW, Martin JN Jr. Antepartum corticosteroids: disease stabilization in patients with the syndrome of hemolysis, elevated liver enzymes and low platelets (HELLP). Am J Obstet Gynecol 1994, 171:1148–1153.
  • Vigil-De Gracia PE, Tenorio-Maroñón RF, Cejudo-Carranza E, Helguera- Martinez A, García-Cáceres E. Differences among preeclampsia, HELLP syndrome and eclampsia. Maternal Evaluation. Ginecol Obstet Mex 1996, 64:337–382.
  • Thiagarajah S, Bourgeois FJ, Harbert GM Jr, Caudle MR. Thrombocytopenia in preeclampsia: associated abnormalities and management principles.Am J Obstet Gynecol 1984, 150:1–7.
  • Yalcin OT, Sener T, Hassa H, Ozalp S, Okur A. Effects of postpartum corticosteroids in patients with HELLP syndrome. Int J Gynecol Obstet 1998, 61:141–148.
  • Suresh MS: HELLP syndrome: An anesthesiologist's perspective. Anesth Clin North Am 1998, 16:332–348.
  • O´Brien JM, Shumate SA, Satchwell SL, Milligan DA, Barton JR. Maternal benefit of corticosteroids therapy in patients with HELLP (hemolysis, elevated liver enzymes and low platelets count) syndrome: Impact on the rate of regional anesthesia. Am J Obstet Gynecol 2002, 186:475–479.
  • Parnas M, Sheiner E, Shoham-Vardi I, Burstein E, Yermiahu T, Levi I, et al. Moderate to severe thrombocytopenia during pregnancy. Eur J Obstet Gynecol Reprod Biol 2006, 128:163-168.
  • Provan D, Stasi R, Newland AC, et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood. 2010;115(2):168-186.
  • Webert KE, Mittal R, Sigouin C, Heddle NM, Kelton JG. A retrospective 11-year analysis of obstetric patients with idiopathic thrombocytopenic purpura. Blood. 2003;102(13):4306-4311.
  • Koyama S, Tomimatsu T, Kanagawa T, Kumasawa K, Tsutsui T, Kimura T. Reliable predictors of neonatal immune thrombocytopenia in pregnant women with idiopathic thrombocytopenic purpura. Am J Hematol. 2012;87(1):15-21.
  • Haddad B, Sibai BM: Expectant management of severe preeclampsia: proper candidates and pregnancy outcome. Clin Obstet Gynecol 2005, 48:430-440.
  • Paruk F, Moodley J: Maternal and neonatal outcome in earlyand late-onset pre-eclampsia. Semin Neonatol 2000, 5:197-207.
  • Fonseca JE, Mendez F, Catano C, Arias F: Dexamethasone treatment does not improve the outcome of women with HELLP syndrome: a doubleblind, placebo-controlled, randomized clinical trial. Am J Obstet Gynecol 2005, 193:1591–1598.
  • Woudstra DM, Chandra S, Hofmeyr GJ, Dowswell T: Corticosteroids for HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome in pregnancy. Cochrane Database of Systematic Reviews. In The Cochrane Library, Volume 12. 2010.

Year 2015, Volume: 10 Issue: 3, 0 - 0, 14.10.2016

Fazil Avcı Murat Bakacak Salih Serin Bülent Köstü Önder Ercan

Abstract

References

  • Sibai BM: The HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets): much ado about nothing? Am J Obstet Gynecol 1990, 162:311–316.
  • Sibai BM. Diagnosis, controversies, and management of the syndrome of hemolysis, elevated liver enzymes, and low platelet count. Obstet Gynecol. 2004;103(5Pt1):981–9.
  • Sullivan CA, Martin JN Jr. Management of the obstetric patient with thrombocytopenia. Clin Obstet Gynecol. 1995;38(3):521-534.
  • Burrows RF, Kelton JG. Fetal thrombocytopenia and its relation to maternal thrombocytopenia. N Engl J Med. 1993;329(20):1463-1466.
  • Geary M: The HELLP syndrome. Br J Obstet Gynaecol 1997, 104:887-891.
  • Karumanchi SA, Maynard SE, Stillman IE, Epstein FH, Sukhatme VP. Preeclampsia: a renal perspective. Kidney Int 2005,67:2101-2113.
  • Sibai BM, Ramadan MK, Usta I, Salama M, Mercer BM, Friedman SA. Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver nzymes, and low platelets (HELLP syndrome). Am J Obstet Gynecol 1993, 169:1000-1006.
  • Magann EF, Martin JN Jr. Twelve steps to optimal management of HELLP syndrome. Clin Obstet Gynecol 1999, 42:532-550.
  • Barton JR, Sibai BM. Diagnosis and management of hemolysis, elevated liver enzymes, and low platelets syndrome. Clin Perinatol 2004, 31:807-33.
  • Martin JN Jr, Rose CH, Briery CM. Understanding and managing HELLP syndrome: the integral role of aggressive glucocorticoids for mother and child. Am J Obstet Gynecol 2006, 195:914-934.
  • Sibai BM: Diagnosis, controversies, and management of the syndrome of hemolysis, elevated liver enzymes, and low platelet count. Obstet Gynecol 2004, 103:981-991.
  • JG, Houthoff HJ, Weits J, Vellenga E, Huisjes HJ. A syndrome of liver damage and intravascular coagulation in the last trimester of normotensive pregnancy. A clinical and histopathological study. Br J Obstet Gynaecol 1986, 93:145-155.
  • Ertan AK, Wagner S, Hendrik HJ, Tanriverdi HA, Schmidt W. Clinical and biophysical aspects of HELLP-syndrome. J Perinat Med 2002, 30:483-489.
  • Magann EF, Bass D, Chauhan SP, Sullivan DL, Martin RW, Martin JN Jr. Antepartum corticosteroids: disease stabilization in patients with the syndrome of hemolysis, elevated liver enzymes and low platelets (HELLP). Am J Obstet Gynecol 1994, 171:1148–1153.
  • Vigil-De Gracia PE, Tenorio-Maroñón RF, Cejudo-Carranza E, Helguera- Martinez A, García-Cáceres E. Differences among preeclampsia, HELLP syndrome and eclampsia. Maternal Evaluation. Ginecol Obstet Mex 1996, 64:337–382.
  • Thiagarajah S, Bourgeois FJ, Harbert GM Jr, Caudle MR. Thrombocytopenia in preeclampsia: associated abnormalities and management principles.Am J Obstet Gynecol 1984, 150:1–7.
  • Yalcin OT, Sener T, Hassa H, Ozalp S, Okur A. Effects of postpartum corticosteroids in patients with HELLP syndrome. Int J Gynecol Obstet 1998, 61:141–148.
  • Suresh MS: HELLP syndrome: An anesthesiologist's perspective. Anesth Clin North Am 1998, 16:332–348.
  • O´Brien JM, Shumate SA, Satchwell SL, Milligan DA, Barton JR. Maternal benefit of corticosteroids therapy in patients with HELLP (hemolysis, elevated liver enzymes and low platelets count) syndrome: Impact on the rate of regional anesthesia. Am J Obstet Gynecol 2002, 186:475–479.
  • Parnas M, Sheiner E, Shoham-Vardi I, Burstein E, Yermiahu T, Levi I, et al. Moderate to severe thrombocytopenia during pregnancy. Eur J Obstet Gynecol Reprod Biol 2006, 128:163-168.
  • Provan D, Stasi R, Newland AC, et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood. 2010;115(2):168-186.
  • Webert KE, Mittal R, Sigouin C, Heddle NM, Kelton JG. A retrospective 11-year analysis of obstetric patients with idiopathic thrombocytopenic purpura. Blood. 2003;102(13):4306-4311.
  • Koyama S, Tomimatsu T, Kanagawa T, Kumasawa K, Tsutsui T, Kimura T. Reliable predictors of neonatal immune thrombocytopenia in pregnant women with idiopathic thrombocytopenic purpura. Am J Hematol. 2012;87(1):15-21.
  • Haddad B, Sibai BM: Expectant management of severe preeclampsia: proper candidates and pregnancy outcome. Clin Obstet Gynecol 2005, 48:430-440.
  • Paruk F, Moodley J: Maternal and neonatal outcome in earlyand late-onset pre-eclampsia. Semin Neonatol 2000, 5:197-207.
  • Fonseca JE, Mendez F, Catano C, Arias F: Dexamethasone treatment does not improve the outcome of women with HELLP syndrome: a doubleblind, placebo-controlled, randomized clinical trial. Am J Obstet Gynecol 2005, 193:1591–1598.
  • Woudstra DM, Chandra S, Hofmeyr GJ, Dowswell T: Corticosteroids for HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome in pregnancy. Cochrane Database of Systematic Reviews. In The Cochrane Library, Volume 12. 2010.
There are 27 citations in total.

Details

Journal Section Makaleler
Authors

Fazil Avcı

Murat Bakacak

Salih Serin

Bülent Köstü

Önder Ercan

Publication Date October 14, 2016
Submission Date October 29, 2014
Published in Issue Year 2015 Volume: 10 Issue: 3

Cite

AMA Avcı F, Bakacak M, Serin S, Köstü B, Ercan Ö. Management Of A Case Of HELLP Syndrome Complicated With Severe Preeclampsia And Immune Thrombocytopenia. KSU Medical Journal. October 2016;10(3).
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