A high LDH to AST ratio helps to differentiate pregnancy-associated thrombotic thrombocytopenic purpura (TTP) from HELLP syndrome

Abstract

A high LDH to AST ratio >22.12 suggests that TTP is a more likely diagnosis than HELLP syndrome in the third trimester pregnant patient, presenting with findings that could be compatible with either diagnosis. In these circumstances, it is advisable to obtain hematology consultation and to consider PEX implementation.

Management of Concurrent Severe Preeclampsia and Thrombotic Thrombocytopenic Purpura (TTP)

“…Some other useful factors including severity of liver disturbances in comparison to hemolysis and dramatic rise in liver function tests are highly suggesting of HELLP syndrome more than the other diagnosis. On the other side data indicating mild liver involvement very high level of LDH, elevated LDH/ AST ratio and gross hematuria support the existence of TTP [19]. Some researchers have said that in cases of ADAMTS13 activity within the range of usually seen at the end of pregnancy [29,30] in other word mild decrease in ADAMTS13 activity allows the rule out TTP, and post-partum severe HELLP syndrome can be proposed.…”

“…We should keep in mind that in new cases of severe hemolysis associated with profound thrombocytopenia, laboratory data should be obtained to rule out TMA [1,3,13,14]. Recently one proposed laboratory finding for TTP is a lactate dehydrogenase (LDH) /aspartate aminotransferase (AST) ratio above 22.12 [19]. In the past pathological criteria were mandatory to define the disease, consisting of glomerular capillary endotheliosis associated with micro vascular platelet thrombi, fibrin formation in and around glomeruli, widespread arterial thrombosis, sub endothelial clear deposits in glomerular capillaries [1,3,18,23,25].…”

“…Many papers have dealt with this question that, whether sever HELLP syndrome particularly in the postpartum period is a form of TMA or not? [5,6,9,[15][16][17][18][19]. Having detailed knowledge of natural history of each disease process and the considerable overlap of them, which make them seem to be "disease syndrome" rather than single disease, will certainly help us to distinguish these related peculiar conditions [6].…”

Egészségügyi szakmai irányelv – A thromboticus thrombocytopeniás purpura (TTP) és a haemolyticus uraemiás syndroma (HUS) kezeléséről

“…A komplement szabályozási zavara már önmagá-ban is másfél-kétszeresére növeli a magzati halálozás és az eclampsia rizikóját [99]. A terhesség alatt a TTP-től elkülönítendő, az ADAMTS13-deficiencia, és a 3. trimesterben a 22 feletti LDH/SGOT [103] arány is a TTP mellett szólnak. A terhesség alatt a HELLP syndroma egyetlen igazoltan hatásos gyógymódja a terhesség befejezése és a placenta eltávolítása.…”

Pre-eclampsia: The Role of Hemostasis in Its Pathophysiology and Potential Future Therapeutic Options

“…The laboratory may help in the differential diagnosis of these conditions. A high LDH to AST ratio (>22.12) has been reported to suggest that TTP may be a more likely diagnosis than HELLP in a woman presenting in the third trimester with fi ndings that could be compatible with either diagnosis [ 73 ]. If a TMA cannot be fully explained by a non-TTP pregnancy-related TMA, then the diagnosis of TTP must be considered and plasma exchange (PEX) should be started (2B) [ 71 ].…”