Hemolysis, elevated liver enzymes, and low platelet syndrome: Outcomes for patients admitted to intensive care at a tertiary referral hospital

Gedik, Ender; Yücel, Neslihan; Şahin, Tevfik Tolga; Koca, Erdinç; Çolak, Yusuf Ziya; Toğal, Türkan

doi:10.1080/10641955.2016.1218505

Cited by 38 publications

(32 citation statements)

References 37 publications

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“…The incidence rate rises to 10-20% for women with preeclampsia (Karumanchi et al, 2005) and to as high as 27.6% for women with eclampsia (Vigil-De Gracia et al, 2015). As a result, a stunning increase in the incidence rate of maternal and perinatal mortality and morbidity was observed in these patients (Sibai et al, 1993;Erdemoglu et al, 2010;Gedik et al, 2017). HELLP syndrome was initially described by Weinstein (1982) and its diagnosis is based on the laboratory analysis of microangiopathic hemolytic anemia, increased levels of liver enzymes, and thrombocytopenia in patients demonstrating symptoms of preeclampsia (Gasem et al, 2009).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Risk and Prognosis Factors of Acute Kidney Injury in Patients With HELLP Syndrome During Pregnancy

et al. 2021

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Hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome complicated with acute renal failure (AKI) is an important cause of maternal mortality and morbidity. The present retrospective study aims to identify risk and prognosis factors that are associated with AKI in patients with HELLP syndrome during pregnancy. A total of 110 pregnant HELLP patients with or without AKI from an 8-year period were studied. 65 of the patients were diagnosed with AKI based on the Kidney Disease Outcomes Quality Initiative criteria. Levels of the lowest hemoglobin and highest serum creatinine and bleeding incidence were identified as independent risk factors for AKI onset. Infection and serum creatinine level were identified as independent risk factors for maternal mortality. In addition, we also found that these factors were significantly different in AKI patients of different severity. The overall complete recovery rate was 67.7% (44 out of 65) for patients with AKI. The overall death rate was 4.5% (5 out of 110), where one of the patient was from the non-AKI group and the other four were from the AKI group. Our results provide valuable indications for clinical doctors during their diagnosis, treatment, and monitoring of recovery status in HELLP patients complicated with AKI.

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Section: Introductionmentioning

confidence: 99%

Evaluation of Risk and Prognosis Factors of Acute Kidney Injury in Patients With HELLP Syndrome During Pregnancy

et al. 2021

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“…Maternal and perinatal complications are frequently observed in patients with this syndrome. Mortality among women with HELLP syndrome was linked with low platelet count, low fibrinogen level, high INR value, and high serum levels of AST, ALT, and LDH, and complications in this patient group are associated with maternal death [27]. A study reported that 30% of patients with HELLP syndrome required mechanical ventilation in the ICU [28].…”

Section: Discussionmentioning

confidence: 99%

Treatment of Obstetric Hemorrhage with Fibrinogen Concentrate

Şahin

Özkan

2019

Med Sci Monit

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BackgroundPostpartum hemorrhage (PPH) is related to several factors but is frequently associated with coagulopathy with maternal mortality. Fibrinogen is a very important agent for bleeding. When its concentration is decreased, severe surgical blood loss may occur. Here, we investigate the association of postpartum bleeding characteristics with evolution of PPH in patients who were taking fibrinogen concentrate (FC).Material/MethodsPPH patients’ demographic parameters, outcome variables, and laboratory findings before and at ICU were recorded between January 2015 and July 2017. The duration of ICU stay and plasmapheresis, renal replacement therapy, maternal-fetal deaths, RBC, FFP, and PC replacement were calculated.ResultsGroup I: Fibrinogen levels were ≤150 mg/dl (n: 31), Group II: Fibrinogen levels were >151 mg/dl (n: 18). In the peroperative period, there was no difference between the 2 groups in terms of RBC, FFP, or PC transfussion. In intraoperative and ICU admission period, patients in Group I had higher INR, APTT, and PT values than in the other group. FC replacement according to fibrinogen level was given, ranging from to 1 to 6 gr in Group I and 1–2 gr in Group II intraoperatively and at ICU 2–8 gr FC was given in both groups. In the intraoperative and ICU admission period, blood transfusion requirements of patients after fibrinogen replacement were evaluated and there was no statistically significant difference between groups. There were no differrences between groups in duration of intensive care unit stay, hospital stay, and mechanical ventilation.ConclusionsAdequate FC therapy prevents unnecessary RBC, FFP, and PC replacement and prevents complications and volume overload.

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“…El diagnóstico de hemólisis se establece mediante biometría hemática y pruebas de funcionamiento hepático (35)(36)(37), en las que se encuentra una disminución de los valores de hematocrito (normal 80-120mg/dl), hematíes fragmentados (esquistocitos), aumento en la deshidrogenasa láctica (DHL) (normal 600U/l), y la bilirrubina >1,2 mg/dL (36,38).…”

Section: Diagnósticounclassified

Características clínicas y fisiológicas del síndrome de Hellp

et al. 2018

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RESUMENEl síndrome de HELLP es una complicación multisistémica del embarazo que se distingue por el trastorno hipertensivo más la triada: hemólisis microangiopática, elevación de enzimas hepáticas y disminución del conteo de plaquetas. Está asociado con la aparición de graves complicaciones perinatales e incremento de la mortalidad materna. Ocurre en 0,5 a 0,9% de todos los embarazos y en 10 a 20% de las pacientes con preeclampsia-eclampsia. Complicaciones obstétricas como ésta deben sospecharse de manera temprana para poderlas atender de manera oportuna y así prevenir situaciones potencialmente fatales tanto para la madre como para el feto. Es por ello, que deben integrarse adecuadamente los signos y síntomas, comprendiendo el reto diagnóstico que este síndrome puede significar.ABSTRACT HELLP syndrome is a severe systemic complication in pregnancy characterized by hypertensive disorder added to the clinical profile that includes: microangiopathic hemolysis, elevation of liver enzymes, and decreased platelet count. It is associated with the appearance of serious perinatal complications and increased maternal mortality. It occurs in 0.5 to 0.9% of all pregnancies and in 10 to 20% of patients with pre-eclampsia/eclampsia. Obstetric complications such as this syndrome need to be suspected in clinical practice, to prevent fatal outcomes for both, the mother and the fetus. Therefore, clinical manifestations should be identified early to approach challenges that the diagnosis may pose.

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Hemolysis, elevated liver enzymes, and low platelet syndrome: Outcomes for patients admitted to intensive care at a tertiary referral hospital

Cited by 38 publications

References 37 publications

Evaluation of Risk and Prognosis Factors of Acute Kidney Injury in Patients With HELLP Syndrome During Pregnancy

Evaluation of Risk and Prognosis Factors of Acute Kidney Injury in Patients With HELLP Syndrome During Pregnancy

Treatment of Obstetric Hemorrhage with Fibrinogen Concentrate

Características clínicas y fisiológicas del síndrome de Hellp

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