The role of hepatic sinusoidal obstruction in the pathogenesis of the hepatic involvement in HELLP syndrome: Exploring the literature

Salmuth, Victoria von; Heiden, Yosta van der; Bekkers, Ilse; Heimel, P. van Runnard; Spaanderman, Marc E. A.; Peeters, Louis L.H.; Koek, Ger H.

doi:10.1016/j.preghy.2019.11.012

Cited by 18 publications

(25 citation statements)

References 82 publications

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“…The hepatic function in HELLP patients improves within 6 weeks of delivery which advocates regarding the placenta as the primary situs involved in the malfunctioning of the liver [17]. The placental factors and vasoactive substances induce an enhanced inflammatory state and endothelial damage (Figure 1), resulting in sinusoidal obstruction syndrome (SOS) [18]. The endothelial damage in the liver is thought to be responsible for the obstruction with red blood cells of the Disse space, an area between liver sinusoidal endothelial cells and hepatocytes [4,19].…”

Section: Placental Pathogenesis Of Hellp Syndromementioning

confidence: 99%

“…These molecules are held accountable for promoting vasoconstriction by decreasing NO production, activating platelets with a shift in hemostasis, and activating LSECs favored by an increased inflammatory state [4]. Apoptosis of LSECs causes red blood cells to enter the space of Disse, where they cause obstruction and eventually lead to liver failure [4,18].…”

Section: Placental Pathogenesis Of Hellp Syndromementioning

confidence: 99%

“…Cytokines are involved in many pathological processes, including cancer and cardiovascular diseases [4]. So far, recent literature has demonstrated their role in innate immunity, cell growth, angiogenesis, apoptosis, and differentiation [4][5][6][7][8]17,18]. Although the precise reason has not yet been fully elucidated, inappropriate levels of cytokines that lead to a series of pathophysiological modifications seem to be the base of HELLP syndrome [4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

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HELLP Syndrome—Holistic Insight into Pathophysiology

et al. 2022

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HELLP syndrome, also known as the syndrome of hemolysis, elevated liver enzymes, and low platelets, represents a severe pregnancy complication typically associated with hypertension. It is associated with increased risks of adverse complications for both mother and fetus. HELLP occurs in 0.2–0.8% of pregnancies, and, in 70–80% of cases, it coexists with preeclampsia (PE). Both of these conditions show a familial tendency. A woman with a history of HELLP pregnancy is at high risk for developing this entity in subsequent pregnancies. We cannot nominate a single worldwide genetic cause for the increased risk of HELLP. Combinations of multiple gene variants, each with a moderate risk, with concurrent maternal and environmental factors are thought to be the etiological mechanisms. This review highlights the significant role of understanding the underlying pathophysiological mechanism of HELLP syndrome. A better knowledge of the disease’s course supports early detection, an accurate diagnosis, and proper management of this life-threatening condition.

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Section: Placental Pathogenesis Of Hellp Syndromementioning

confidence: 99%

Section: Placental Pathogenesis Of Hellp Syndromementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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HELLP Syndrome—Holistic Insight into Pathophysiology

et al. 2022

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“…Debido a que no se ha dilucidado la fisiopatología del síndrome de HELLP, el manejo de la patología se limita a internamiento, tratamiento sintomático, monitorización y terminación del embarazo (18). El manejo del síndrome también depende de la edad gestacional en la cual se realiza el diagnóstico, al igual que las condiciones maternas y fetales al momento del diagnóstico, como se muestra en la figura 1 (6).…”

Section: Manejounclassified

“…Este síndrome tiene un alto índice de mortalidad, el cual se estima entre un 1 al 24% de las madres (4,11,18). En el caso de América Latina, se estima que es del 14%(4).…”

Section: Manejounclassified

Actualización y conceptos claves del Síndrome de HELLP

Sánchez

Steller

Méndez

et al. 2020

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El síndrome de HELLP es una afección del embarazo, el cual presenta la triada de hemólisis, elevación de enzimas hepáticas y trombocitopenia. Este síndrome se caracteriza por presentar una afectación multisistémica, además de presentar una alta morbimortalidad materno-fetal. Se estima que afecta entre 0,1 a 0,9% de los embarazos, entre las 27-37 semanas de gestación principalmente; y 10-20% también presentan preeclampsia. Estas pacientes refieren típicamente dolor en epigastrio o cuadrante superior derecho del abdomen, náuseas y/o vómitos. El diagnóstico se realiza por medio de la presencia de la tríada: anemia microangiopática, elevación de enzimas hepáticas y trombocitopenia. Se debe brindar manejo hospitalario y multidisciplinario debido a las posibles complicaciones de la madre y el feto. El tratamiento es sintomático y la realización del parto entre 24-48 horas posterior al diagnóstico.

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Investigating hemolysis, elevated liver enzymes and low platelet count in preeclampsia: A case‐control study in Ghana

Akilla,

Nchor Awinibuno,

Banyeh

et al. 2024

Health Science Reports

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Background and AimsPreeclampsia poses a heightened risk for women, particularly in the development of hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome, leading to adverse outcomes for both mothers and newborns. The incidence of HELLP syndrome tends to be notably higher among women with preeclampsia compared with those with normotensive pregnancies. However, there is a dearth of research on the frequency of HELLP syndrome within the context of preeclampsia specifically in Ghana. Furthermore, the potential predictive value of serum erythrocyte adenylate kinase (EAK), a marker of hemolysis, in anticipating the onset of preeclampsia remains largely unexplored.MethodsConducted between May 2020 and April 2022, this research employed a case‐control methodology at the War Memorial and Upper East Regional Hospitals. A total of 291 pregnant women participated, comprising 111 diagnosed with preeclampsia and 180 control subjects, aged between 18 and 43 years. Venous blood samples were collected and subjected to analysis for platelet count, aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), and EAK, utilizing automated analyzers, alongside the ELISA technique. Diagnosis of HELLP syndrome was established using the Mississippi triple‐class definition.ResultsThe median serum ALT level (with interquartile range) was significantly elevated in the preeclampsia group compared with controls [20.0 (13.7–27.0) vs. 13.0 (9.4–18.6); p < 0.001]. Moreover, the frequency of Mississippi class 3 HELLP syndrome was notably higher among preeclampsia cases (2/111; 1.8%) compared with controls (1/180; 0.6%). Serum ALT emerged as the superior predictor of preeclampsia, outperforming LDH (with an area under the curve of 0.73 compared with 0.58). The sensitivity and specificity of ALT were measured at 47.8% and 87.2%, respectively.ConclusionAlthough the occurrence of HELLP syndrome in preeclampsia cases appears relatively low, it may escalate as the prevalence of preeclampsia is anticipated to rise in low and middle‐income nations.

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The role of hepatic sinusoidal obstruction in the pathogenesis of the hepatic involvement in HELLP syndrome: Exploring the literature

Cited by 18 publications

References 82 publications

HELLP Syndrome—Holistic Insight into Pathophysiology

HELLP Syndrome—Holistic Insight into Pathophysiology

Actualización y conceptos claves del Síndrome de HELLP

Investigating hemolysis, elevated liver enzymes and low platelet count in preeclampsia: A case‐control study in Ghana

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