Síndrome HELLP: controversias y pronóstico

Lastra, M. Arigita; Fernández, Guillermo Sebastian Martínez

doi:10.1016/j.hipert.2020.07.002

Cited by 13 publications

(12 citation statements)

References 21 publications

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“…has been documented that lactic dehydrogenase (LDH) enzyme is a useful tool to identify hepatocellular damage as an individual finding of severe preeclampsia (SP) or as part of the HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count) [4]. Specifically, blood concentration of the LDH enzyme ≥ 600 U/L has been directly related to an increase in maternal and perinatal mortality [5].…”

Section: Itmentioning

confidence: 99%

Lactic Dehydrogenase Enzyme and Acid-Base Status in Severe Preeclampsia: A Case-Control Study Investigating the Impact of Obesity

Rodríguez,

Martínez

2023

JAMMR

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Aims: Compare and correlate blood concentration of the LDH enzyme and arterial blood gas parameters of pregnant patients with severe preeclampsia (SP) with and without obesity. Study Design: Case-control study. Place and Duration of Study: Intensive Care Unit of High Specialty Medical Unit, Gynecology and Obstetrics Hospital No. 3. National Medical Center “La Raza”, Mexican Institute of Social Security, Mexico City, in the year 2022. Methodology: Case-control study carried out in 73 pregnant patients with SP. Case group: 34 patients with pregestational Body Mass Index (BMI) with obesity (BMI >30) who remained obese during pregnancy. Control group: 39 women matched by gestational age with normal pregestational BMI (BMI <25) who remained with BMI normal during pregnancy. Blood concentration of total LDH enzyme and arterial blood gas parameters upon admission to the Intensive Care Unit (ICU) were compared. The LDH correlations vs arterial blood gas parameters were calculated. Statistical analysis: descriptive statistics, paired Student's t test and Pearson correlation coefficient (r) were used with the SPSS™ version 24 program. The P value <0.05 was significant. Results: No differences were found in the blood concentration of total LDH enzyme (case group 669.54±71.79 vs control group 474.75±30.33 U/L, P= .21). The arterial blood gas parameters showed data of compensated metabolic acidosis in both groups, but without significant differences (pH P= .42, lactate P= .060, bicarbonate P= .89, std bicarbonate P= .74, ecf base deficit P= .93, base deficit P= .73). The correlations between blood concentration of total LDH enzyme and arterial blood gas parameters were not significant. Conclusion: Blood concentration of total LDH enzyme was similar. Both groups showed compensated metabolic acidosis without differences of gasometric parameters. No significant correlations were found.

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Section: Itmentioning

confidence: 99%

Lactic Dehydrogenase Enzyme and Acid-Base Status in Severe Preeclampsia: A Case-Control Study Investigating the Impact of Obesity

Rodríguez,

Martínez

2023

JAMMR

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“…Childbearing age people are susceptible to the illness known as HELLP, which is marked by hemolysis along with a microangiopathic blood smear, increased liver enzymes, as well as low platelets [67][68][69]. A single course of corticosteroid medication for fetal lung maturation, either two doses of 12 mg betamethasone 24 hours apart or six doses of dexamethasone 12 hours apart, is favoured in gestational ages between 24 and 34 weeks.…”

Section: Hemolysis Elevated Liver Enzymes and Low Platelet (Hellp) Sy...mentioning

confidence: 99%

Recent Advances in the Management of Microangiopathic Hemolytic Anemias (MAHA): A Narrative Review

Pande,

Kumar,

Krishnani

et al. 2023

Cureus

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Red blood cells (RBCs) start to break down early in hemolytic anemia, which can be chronic or lifethreatening. It should be considered while determining if normocytic or macrocytic anemia is present. Hemolysis in the reticuloendothelial system may happen intravascularly, extravascularly, or both. It accounts for a broad spectrum of laboratory and clinical situations, both physiological and pathological. Whenever the frequency of RBC breakdown is rapid enough to lower hemoglobin levels below the normal range, hemolytic anemia occurs. Microangiopathic hemolytic anemia (MAHA) is a term used to describe non-immune hemolysis induced by intravascular RBC fragmentation caused by substances in the tiny blood arteries that generate schistocytes in the peripheral circulation. Microvasculature abnormalities, such as small arterioles and capillaries, are usually involved. Furthermore, MAHA can also be brought on by intravascular devices like a prosthetic heart valve or assistive technologies. Poor deformity results in entrapment, phagocytosis, antibody-mediated elimination through phagocytosis or direct complement activation, fragmentation brought about by microthrombi or acute mechanical stress, oxidation, or spontaneous cellular death. Hemolysis may cause acute anemia, jaundice, hematuria, dyspnea, tiredness, tachycardia, and possibly hypotension. This article aims to synthesize existing research, identify therapeutic strategies, and provide insights into current and emerging approaches for managing this complex hematological disorder.

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“…Contudo, ressalta-se que podem haver casos assintomáticos ou com sintomas adicionais, como cefaleia, alterações visuais e de consciência (ACOG, 2019;LASTRA;FERNÁNDEZ, 2020).…”

Section: Introductionunclassified

Síndrome HELLP: aspectos fisiopatológicos, métodos diagnósticos e condutas terapêuticas

Costa¹,

Pereira²,

Leopoldino³

et al. 2023

Braz. J. Develop.

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A síndrome HELLP é uma condição na qual a gestante apresenta hemólise, aumento de enzimas hepáticas e plaquetopenia, sendo considerada uma manifestação grave da pré-eclâmpsia. Nos casos em que há um ou dois desses critérios, denomina-se síndrome HELLP parcial ou incompleta. A patogênese ainda carece de completo esclarecimento, contudo acredita-se que esteja relacionada à fatores placentários que desencadeiam uma resposta inflamatória sistêmica exacerbada, além de mutações genéticas que contribuem com o dano endotelial e, consequentemente, podem predispor à condição. Epidemiologicamente, sabe-se que a maior incidência ocorre entre 27 e 37 semanas de gestação, embora possa ocorrer em até 7 dias após o parto. Os principais fatores de risco incluem o histórico de distúrbios hipertensivos em gestações prévias, a nuliparidade e a idade materna superior a 35 anos. Clinicamente, é comum que a paciente manifeste sinais clássicos de pré-eclâmpsia (hipertensão e proteinúria), além de dor epigástrica e no quadrante superior direito, náuseas e vômitos, sendo que a sintomatologia tem início súbito e raramente cursa com remissão espontânea. Vale ressaltar que a síndrome pode ser assintomática e possui diagnósticos diferenciais importantes, como hepatites virais, anemia hemolítica e fígado gorduroso agudo da gravidez. Para o diagnóstico da síndrome HELLP completa, considera-se a elevação das enzimas LDH acima de 600 unidades/L, ALT e AST acima de duas vezes o limite superior, além de contagem de trombócitos inferior à 100.000 x 109/L. O manejo terapêutico envolve o parto imediato, preferencialmente via vaginal, quando a IG ≥ 34 semanas e a conduta expectante, associada à administração de corticosteróides, quando a IG < 34 semanas e houver estabilidade clínica materno-fetal. A terapia medicamentosa inclui o uso de sulfato de magnésio para a prevenção da eclâmpsia e de hipotensores de ação rápida.

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Síndrome HELLP: controversias y pronóstico

Cited by 13 publications

References 21 publications

Lactic Dehydrogenase Enzyme and Acid-Base Status in Severe Preeclampsia: A Case-Control Study Investigating the Impact of Obesity

Lactic Dehydrogenase Enzyme and Acid-Base Status in Severe Preeclampsia: A Case-Control Study Investigating the Impact of Obesity

Recent Advances in the Management of Microangiopathic Hemolytic Anemias (MAHA): A Narrative Review

Síndrome HELLP: aspectos fisiopatológicos, métodos diagnósticos e condutas terapêuticas

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