Hemolysis in Hypertensive Disorders of Pregnancy

Schröcksnadel, H.; Sitte, B.; Steckel-Berger, Gabriele; Dapunt, O

doi:10.1159/000292763

Cited by 20 publications

(7 citation statements)

References 7 publications

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“…Although the AST values in these patients were somewhat lower than those seen in previous cases of the HELLP syndrome, the clinical features and changes in laboratory variables, including antithrombin III activity [11,15] and the LDH level [16,17], were similar to those of the HELLP syndrome. It is possible that our patients exhibited only a slight increase in AST because of our early intervention policy, which is based on our earlier experience [18][19][20][21].…”

Section: Discussioncontrasting

confidence: 56%

Relation between Gestational Thrombocytopenia and the Syndrome of Hemolysis, Elevated Liver Enzymes, and Low Platelet Count (HELLP Syndrome)

Minakami

Kohmura²,

Izumi³

et al. 1998

Gynecol Obstet Invest

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Objective: To define the clinical features of gestational thrombocytopenia and to determine its relationship to the syndrome of hemolysis, elevated liver enzymes, and low platelet count (HELLP syndrome). Study Design: Retrospective cohort study. We reviewed the records of 24 women with gestational thrombocytopenia among 637 nonpreeclamptic women who had serial determinations of the platelet count during pregnancy between 1992 and 1995. Gestational thrombocytopenia was defined as an antenatal gradual decline in the platelet count to <150 × 10⁹/l in nonpreeclamptic women. The control group consisted of 213 nonpreeclamptic women whose platelet counts were ≥150 × 10⁹/l at –3 to 0 days from delivery and in whom the perinatal serum level of aspartate transaminase (AST) had been determined. Results: The platelet count decreased gradually, from 210 ± 31 × 10⁹/l at <13 weeks’ gestation to 127 ± 24 × 10⁹/l at –3 to 0 days from delivery, in the 24 women with gestational thrombocytopenia. The platelet count was 251 ± 62 × 10⁹/l at –3 to 0 days from delivery in the 213 control women. The serum level of AST was elevated perinatally in 5 (21%) of 24 women with gestational thrombocytopenia compared with 6 (2.8%) of the 213 control subjects (p < 0.001). There had been 28 previous term or near-term pregnancies among 17 women with gestational thrombocytopenia, 14 of which were complicated by gestational thrombocytopenia or a decline in the platelet count by >50 × 10⁹/l; 1 pregnancy was associated with the features typical of the HELLP syndrome. Conclusion: Gestational thrombocytopenia may be a risk factor for the development of the HELLP syndrome and is likely to recur in subsequent pregnancies.

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Section: Discussioncontrasting

confidence: 56%

Relation between Gestational Thrombocytopenia and the Syndrome of Hemolysis, Elevated Liver Enzymes, and Low Platelet Count (HELLP Syndrome)

Minakami

Kohmura²,

Izumi³

et al. 1998

Gynecol Obstet Invest

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“…B. ein Anstieg des LDH-Isoenzym-5 als Ausdruck einer Leberschädigung findet [2]. Andere Hämolyseparameter wie Fragmentozyten im peripheren Blutausstrich eignen sich mit einer zu geringen Sensitivität nicht [12].…”

Section: Abstract Hellp´haptoglobin´pregnancyunclassified

Isolierter Haptoglobinabfall in der Schwangerschaft: Zufallsbefund oder pathologisch? - Diskutiert anhand eines Fallberichtes -

et al. 2002

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Haptoglobin is an acute-phase-protein, which is important in many diseases like infections, trauma and neoplasma. An increase in haptoglobin is induced by cytocines like IL-6 und IL-1. The normal range for plasmatic haptoglobin is 50-220 mg/dl. During pregnancy the most likely diagnosis is the HELLP- Syndrome (hemolysis, elevated liver enzymes and low platelets), followed by rare diagnoses like viral hepatitis or favism. We report about a 31-year-old III-gravida 0-para at 31 weeks of gestation with a decrease of haptoglobin over a period of 6 weeks (cut off: < 13 mg/dl) and without any clinical signs of preeclampsia. Liver enzymes were constantly slightly elevated without any progress, other laboratory test results were normal. The patient had a caesarean section at 37 weeks of gestation. Serum haptoglobin returned to normal values within three days after delivery. The reason for the decrease of haptoglobin in our case remains uncertain. Further studies need to focus on the differential diagnosis of a decrease of haptoglobin as well as an isolated decrease of haptoglobin during pregnancy and on the valid ranges of the different haptoglobin subtypes.

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“…When haemolysis has been mentioned, the diagnosis was based largely on the presence of an abnormal peripheral smear (burr cells or schistocytes 14 are suggestive of a micro‐haemangiopathic haemolytic anaemia) or a raised reticulocyte count. A low haptoglobin level is also a useful marker of haemolysis 15,16 . Other haemolysis markers include lactate dehydrogenase, bilirubin (serum, urine), urobilinogen (urine), fragmentocytes and free haemoglobin 16 In the most severe cases, disseminated intravascular coagulation (DIG) will co‐exist with the haemolytic anaemia.…”

Section: Diagnosis and Classificationmentioning

confidence: 99%

“…A low haptoglobin level is also a useful marker of haemolysis 15,16 . Other haemolysis markers include lactate dehydrogenase, bilirubin (serum, urine), urobilinogen (urine), fragmentocytes and free haemoglobin 16 In the most severe cases, disseminated intravascular coagulation (DIG) will co‐exist with the haemolytic anaemia. The syndrome of ELLP has been described where there has been no haemolysis 5 .…”

Section: Diagnosis and Classificationmentioning

confidence: 99%