Anesthetic management of a parturient with hemolysis, elevated liver enzyme levels, and low platelet syndrome complicated by renal insufficiency and coagulopathy

Abstract

The objective of this study is to describe the anesthetic management of a parturient with hemolysis, elevated liver enzyme levels, and low platelet (HELLP) syndrome and renal insufficiency. A 28-year-old female patient, gestational age of 35 weeks, with hypertensive crisis (blood pressure 190/110 mmHg), was admitted for an emergency cesarean section after diagnosis of HELLP syndrome and renal insufficiency. We performed total intravenous general anesthesia with rapid sequence induction. During the surgical procedure, reduced urine output and coagulopathy were detected. After the treatments of transfusion, diuresis, and anticoagulation, the surgery finished uneventfully. The patient was taken to the Intensive Care Unit without extubation and discharged on the 6th postoperative day. This case report revealed a successful anesthetic management applied to a pregnant woman with HELLP syndrome complicated by renal insuffciency and coagulopathy. There are several case reports about HELLP syndrome, but the patient in this paper is complicated with renal insuffciency and coagulopathy which made the treatment diffcult to handle.

Anesthetic Management in a Post-COVID Hemolysis, Elevated Liver Enzymes, and Low Platelet Count (HELLP) Patient in Rural Central India: A Close Shave

“…The judgment to employ anesthesia for preeclampsia patients is based on a comprehensive assessment of the advantages and hazards that anesthesia can provide to both mothers and newborns [2]. With neuraxial anesthetic procedures where coagulopathy along with thrombocytopenia, increases the risk of epidural hematoma [3]. Granted that there is no statistical data in the literature on the effects of neuraxial blockade in patients with HELLP syndrome and platelet counts below the specified value, guidelines recommend a platelet count of 100,000 mm to limit the risk [4].…”