Relation between Gestational Thrombocytopenia and the Syndrome of Hemolysis, Elevated Liver Enzymes, and Low Platelet Count (HELLP Syndrome)

Abstract

Objective: To define the clinical features of gestational thrombocytopenia and to determine its relationship to the syndrome of hemolysis, elevated liver enzymes, and low platelet count (HELLP syndrome). Study Design: Retrospective cohort study. We reviewed the records of 24 women with gestational thrombocytopenia among 637 nonpreeclamptic women who had serial determinations of the platelet count during pregnancy between 1992 and 1995. Gestational thrombocytopenia was defined as an antenatal gradual decline in the platelet count to <150 × 10⁹/l in nonpreeclamptic women. The control group consisted of 213 nonpreeclamptic women whose platelet counts were ≥150 × 10⁹/l at –3 to 0 days from delivery and in whom the perinatal serum level of aspartate transaminase (AST) had been determined. Results: The platelet count decreased gradually, from 210 ± 31 × 10⁹/l at <13 weeks’ gestation to 127 ± 24 × 10⁹/l at –3 to 0 days from delivery, in the 24 women with gestational thrombocytopenia. The platelet count was 251 ± 62 × 10⁹/l at –3 to 0 days from delivery in the 213 control women. The serum level of AST was elevated perinatally in 5 (21%) of 24 women with gestational thrombocytopenia compared with 6 (2.8%) of the 213 control subjects (p < 0.001). There had been 28 previous term or near-term pregnancies among 17 women with gestational thrombocytopenia, 14 of which were complicated by gestational thrombocytopenia or a decline in the platelet count by >50 × 10⁹/l; 1 pregnancy was associated with the features typical of the HELLP syndrome. Conclusion: Gestational thrombocytopenia may be a risk factor for the development of the HELLP syndrome and is likely to recur in subsequent pregnancies.

Clinical features of gestational thrombocytopenia difficult to differentiate from immune thrombocytopenia diagnosed during pregnancy

“…While George et al . stated that, for women with mild thrombocytopenia who do not need treatment, the distinction from ITP may not be important during the pregnancy, Minakami et al . reported that GT is a high‐risk factor for HELLP syndrome.…”

“…Because of these findings, we consider our study to be of clinical significance. While George et al 19 stated that, for women with mild thrombocytopenia who do not need treatment, the distinction from ITP may not be important during the pregnancy, Minakami et al 20,21 reported that GT is a high-risk factor for HELLP syndrome. Although the final diagnosis can be made only after delivery, careful monitoring is necessary for women with thrombocytopenia with platelet counts of less than 100 000/μL, even for cases that do not require treatment during pregnancy.…”

Liver dysfunction in women with pregnancy‐induced antithrombin deficiency

“…3.2% of pregnant women develop liver dysfunction peri‐partum . Liver dysfunction is likely to occur in pregnant women with gestational thrombocytopenia leading to diagnosis of the syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome). However, liver dysfunction can occur even in the absence of thrombocytopenia; some patients with acute fatty liver of pregnancy (AFLP) lack thrombocytopenia, but have liver dysfunction at presentation .…”

Antithrombin III activity and platelet count are more likely to decrease in twin pregnancies than in singleton pregnancies

“…However, to our knowledge, this issue has not been extensively studied. Because women who exhibit a gradual decline in AT‐III activity and/or platelet count appear to be at higher risk of developing of the HELLP syndrome (15, 16) and because the number of multifetal pregnancies is increasing due to ovulation induction and in vitro fertilization (17), it is important to better characterize the changes in these parameters in twin and singleton pregnancies. Accordingly, we prospectively determined AT‐III activity and platelet count in 56 women with twin pregnancies and 692 women with singleton pregnancies to determine whether antithrombin III activity and platelet count are more likely to decrease in women with twin pregnancies than singleton pregnancies.…”