Anesthetic management of HELLP syndrome complicating primary antiphospholipid syndrome -A case report-

Abstract

Antiphospholipid syndrome (APS) is defined as an autoimmune disorder characterized by recurrent thrombosis or obstetrical morbidity. A 29-year-old woman who was diagnosed with APS underwent emergency cesarean delivery at 23 weeks' gestation. She had a seizure attack and her laboratory findings were: AST/ALT 1459/1108 IU/L, LDH 1424 IU/L, 30% hematocrit, a platelet count of 43 × 103/ml and urine protein (4+). We describe the anesthetic experience of catastrophic HELLP syndrome with antiphospholipid syndrome and we review the relevant literature.

Catastrophic antiphospholipid syndrome presented with sudden renal failure and history of long-lasting psychosis and hypertension in a 42 years old women

“…Early recognition of APS is crucial, while aggressive management can result in a favorable outcome (2)(3)(4)(5). The recognized renal manifestations of this syndrome defined as APS nephropathy, are the renal artery thrombosis/stenosis, renal vein thrombosis, renal infarction, end-stage renal disease, increased allograft vascular thrombosis, some types of glomerular disease, hypertension and thrombotic microangiopathy (TMA) (1,2,(10)(11)(12). TMA is characterized by acute thrombotic lesions in glomeruli and/ or arterioles and chronic vascular lesions such as fibrous intimal hyperplasia of arterioles and interlobular arteries, organized thrombi with or without recanalization, and fibrous arterial and arteriolar occlusions or focal cortical atrophy (3)(4)(5)(6)(7)(8)(9).…”

“…The final diagnosis of APS can be made only if patient have TMA plus clinical and laboratory data (anti-cardiolipin antibody). The most frequent clinical and laboratory characteristics of APSN are hypertension (often severe), proteinuria (ranging from mild to nephrotic range), hematuria, and acute or chronic renal insufficiency (12)(13)(14).…”