Comparing acute fatty liver of pregnancy from hemolysis, elevated liver enzymes, and low platelets syndrome

Byrne, John J.; Seasely, Angela R.; Nelson, David B.; McIntire, Donald D.; Cunningham, F. Gary

doi:10.1080/14767058.2020.1754790

Cited by 16 publications

(9 citation statements)

References 46 publications

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“…Patients should be monitored for the development of hypoglycaemia, pancreatitis and diabetes insipidus. 17 In general, patients with peripartum causes of liver impairment tend to improve, but progression to liver failure in HELLP is still associated with a 11.5% mortality rate. Notably, King's College criteria are poor predictors of death or need for liver transplantation in this cohort of patients and the presence of encephalopathy and a high lactate are better predictors of disease severity.…”

Section: Investigationsmentioning

confidence: 99%

Haemolysis, elevated liver enzymes and low platelets: Diagnosis and management in critical care

Poimenidi

Metodiev

Archer

et al. 2021

Journal of the Intensive Care Society

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A thirty-year-old pregnant woman was admitted to hospital with headache and gastrointestinal discomfort. She developed peripheral oedema and had an emergency caesarean section following an episode of tonic-clonic seizures. Her delivery was further complicated by postpartum haemorrhage and she was admitted to the Intensive Care Unit (ICU) for further resuscitation and seizure control which required infusions of magnesium and multiple anticonvulsants. Despite haemodynamic optimisation she developed an acute kidney injury with evidence of liver damage, thrombocytopenia and haemolysis. Haemolysis, Elevated Liver enzymes and Low Platelets (HELLP) syndrome, a multisystem disease of advanced pregnancy which overlaps with pre-eclampsia, was diagnosed. HELLP syndrome is associated with a range of complications which may require critical care support, including placental abruption and foetal loss, acute kidney injury, microangiopathic haemolytic anaemia, acute liver failure and liver capsule rupture. Definitive treatment of HELLP is delivery of the fetus and in its most severe forms requires admission to the ICU for multiorgan support. Therapeutic strategies in ICU are mainly supportive and include blood pressure control, meticulous fluid balance and possibly escalation to renal replacement therapy, mechanical ventilation, neuroprotection, seizure control, and management of liver failure-related complications. Multidisciplinary input is essential for optimal treatment.

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Section: Investigationsmentioning

confidence: 99%

Haemolysis, elevated liver enzymes and low platelets: Diagnosis and management in critical care

Poimenidi

Metodiev

Archer

et al. 2021

Journal of the Intensive Care Society

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“…Hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome is an extremely advanced form of preeclampsia that includes a triad of hemolysis, elevated liver enzymes, and low platelets in the blood 1 . It is a multisystemic disease characterized by a sudden and often rapid deterioration of maternal and fetal well‐being 2 . It is seen at a frequency of approximately 10%–20% in patients with severe preeclampsia 2 .…”

Section: Introductionmentioning

confidence: 99%

“…It is a multisystemic disease characterized by a sudden and often rapid deterioration of maternal and fetal well‐being 2 . It is seen at a frequency of approximately 10%–20% in patients with severe preeclampsia 2 . Currently, no definite etiology has been determined of this disease that is progressing with multiple organ dysfunctions 3,4 .…”

Section: Introductionmentioning

confidence: 99%

May human epididymis 4 protein play a role in the etiopathogenesis of hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome?

Cam

Senocak

Öztürk

et al. 2021

J of Obstet and Gynaecol

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Aim Hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome is an extremely advanced form of preeclampsia. Currently, there is no parameter or marker to predict this syndrome; however, it is emphasized that vascular endothelial damage and abnormal immune responses can be the possible etiologies of HELLP syndrome. It is known that human epididymis protein 4 (HE4) is a protease inhibitor and previous studies have shown that HE4 protein levels are increased in many malignancies and inflammatory conditions. Considering that metalloproteinases may also play a role in endothelial damage, which is thought to be involved in the etiopathogenesis of HELLP syndrome, we thought that HE4 protein, which is a protease inhibitor, may be associated with vascular damage. We aimed to investigate the relationship between HELLP syndrome and HE4 protein and to identify a biomarker that can be utilized in the diagnosis of HELLP syndrome. Study Design In this study, 40 patients with HELLP syndrome and 40 healthy pregnant women with similar characteristics without HELLP syndrome were compared. Results When the results were evaluated, no statistically significant difference was found between serum HE4 protein levels in patients with HELLP syndrome and patients without HELLP syndrome in this study (p: 0.29). Conclusion HE4 protein has no field of use in obstetrics yet. In our study, we aimed to find a new biomarker to identify patients with HELLP syndrome. However, we could not find any statistically significant difference in terms of HE4 protein levels between patients with and without HELLP syndrome. Our study is an important study as it is the first study aiming to use HE4 protein in obstetrics.

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“…Acute fatty liver of pregnancy (AFLP) is a rare but highly morbid disease. The majority of AFLP cases are diagnosed in the third trimester of pregnancy or during the early postpartum period with some isolated reports occurring in the second trimester of pregnancy [ 1 ]. The disease is characterized by jaundice, coagulopathy, and signs and symptoms of hepatic and renal failure [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

A Rare Disease Presenting Postpartum: Acute Fatty Liver of Pregnancy

Córdoba-Vives

Pérez-Rodríguez

Marín-Delgado

et al. 2021

Case Reports in Obstetrics and Gynecology

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Acute fatty liver of pregnancy is a rare but highly fatal disease affecting women most frequently during the third trimester of pregnancy or in the postpartum period. It is considered a diagnosis of exclusion and requires a timely diagnosis to avoid maternal mortality. We present the case of a 33-year-old primigravida who required an emergency cesarean section due to fetal bradycardia. On postoperative day one, the patient was noted jaundiced, oliguric, and hypoglycemic. Laboratory tests revealed important hepatic dysfunction, coagulopathy, and renal failure. She was admitted to the Intensive Care Unit with the suspicion of acute fatty liver of pregnancy. Plasma exchange was started on postoperative day 5 with major clinical and laboratory improvement. A transjugular hepatic biopsy confirmed the diagnosis. The patient had satisfactory evolution and was discharged 15 days after delivery. Acute fatty liver of pregnancy is a highly morbid disease that needs a high index of suspicion to be diagnosed. Admission to an Intensive Care Unit to ensure maximum supportive care is mandatory in this disease.

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Comparing acute fatty liver of pregnancy from hemolysis, elevated liver enzymes, and low platelets syndrome

Cited by 16 publications

References 46 publications

Haemolysis, elevated liver enzymes and low platelets: Diagnosis and management in critical care

Haemolysis, elevated liver enzymes and low platelets: Diagnosis and management in critical care

May human epididymis 4 protein play a role in the etiopathogenesis of hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome?

A Rare Disease Presenting Postpartum: Acute Fatty Liver of Pregnancy

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