HELLP Syndrome: Difference between revisions
No edit summary |
No edit summary |
||
| Line 7: | Line 7: | ||
== Definition/Description == | == Definition/Description == | ||
[[Image:Liver.jpg| | [[Image:Liver.jpg|border|left|230x200px|A liver affected by HELLP Syndrome]] | ||
<br> | <br> | ||
| Line 23: | Line 23: | ||
<br> | <br> | ||
<br>[Image courtesy of | <br>[Image courtesy of [http://www.ispub.com/journal/the_internet_journal_of_anesthesiology.html The Internet Journal of Anesthesiology]] | ||
== Prevalence == | == Prevalence == | ||
| Line 32: | Line 32: | ||
Approximately 7 out of 10 patients with HELLP syndrome will experience the symptoms prior to delivery between the 27th and 37th week of gestation. The remaining patients will develop the symptoms within 48 hours postpartum.<ref name="Haram" /> | Approximately 7 out of 10 patients with HELLP syndrome will experience the symptoms prior to delivery between the 27th and 37th week of gestation. The remaining patients will develop the symptoms within 48 hours postpartum.<ref name="Haram" /> | ||
There are two classifications of HELLP Syndrome:<ref name="Padden" /> | |||
*Classification 1: Basis of 3 classic lab values | |||
- Partial: one/two of the classic values present | |||
- Full: all three abnormalities present | |||
(''Full HELLP syndrome classifications have a higher should be delivered within 48 hours'') | |||
*Classification 2: Basis of platlet count | |||
- Class 1: Platlet count < 50,000 mm<sup>3</sup> | |||
- Class 2: Platlet count 50,000-100,000 mm<sup>3</sup> | |||
- Class 3: Platlet count 100,000-150,000 mm<sup>3</sup> | |||
(''Class 1 pts have a higher maternal morbidity and mortality'') | |||
Clinical symptoms of HELLP include discomfort in the upper right quadrant of the abdomen, pain in the epigastric area, vomiting, and nausea.<ref name="Haram">Haram, K. Svendsen, E. Abildgaard, U. The HELLP syndrome: Clinical issues and management. A Review. BMC Pregnancy Childbirth [serial online]. 2009; 9:8.</ref> The abdominal discomfort can increase and decrease throughout the day.<ref name="Sibai">Sibai BM. Diagnosis, controversies, and management of the syndrome of hemolysis, elevated liver enzymes, and low platelet count. Obstetrics and Gynecology [serial online]. 2004;103:981–991.</ref> Patients can report extreme fatigue prior to presentation or ‘feeling unwell’.<ref name="Sibai" /><ref name="PubMed" /> Other symptoms include headache, fluid retention, excess weight gain, blurry vision, nosebleeds (or bleeding that does not stop easily), seizures/convulsions.<ref name="PubMed" /> | Clinical symptoms of HELLP include discomfort in the upper right quadrant of the abdomen, pain in the epigastric area, vomiting, and nausea.<ref name="Haram">Haram, K. Svendsen, E. Abildgaard, U. The HELLP syndrome: Clinical issues and management. A Review. BMC Pregnancy Childbirth [serial online]. 2009; 9:8.</ref> The abdominal discomfort can increase and decrease throughout the day.<ref name="Sibai">Sibai BM. Diagnosis, controversies, and management of the syndrome of hemolysis, elevated liver enzymes, and low platelet count. Obstetrics and Gynecology [serial online]. 2004;103:981–991.</ref> Patients can report extreme fatigue prior to presentation or ‘feeling unwell’.<ref name="Sibai" /><ref name="PubMed" /> Other symptoms include headache, fluid retention, excess weight gain, blurry vision, nosebleeds (or bleeding that does not stop easily), seizures/convulsions.<ref name="PubMed" /> | ||
| Line 79: | Line 99: | ||
== Medical Management (current best evidence) == | == Medical Management (current best evidence) == | ||
In patients diagnosed with HELLP syndrome prior to delivery, the immediate treatment is delivery of the fetus.<ref name="Bacq">Bacq Y. Liver diseases unique to pregnancy: A 2010 update. Clinics and Research in Hepatology and Gastroenterology. 2011; 20: (Article in Press) Available at http://www.sciencedirect.com.libproxy.bellarmine.edu/science?_ob=ArticleListURL&amp;amp;amp;amp;_method=list&amp;amp;amp;amp;_ArticleListID=1651726142&amp;amp;amp;amp;_sort=r&amp;amp;amp;amp;_st=13&amp;amp;amp;amp;view=c&amp;amp;amp;amp;_acct=C000069778&amp;amp;amp;amp;_version=1&amp;amp;amp;amp;_urlVersion=0&amp;amp;amp;amp;_userid=6406088&amp;amp;amp;amp;md5=a96535ccc1419c813a4019495931cad1&amp;amp;amp;amp;searchtype=a. Accessed 22 February 2011.</ref> If the fetus is earlier than 34 weeks gestation, steroid injections and close monitoring for 24-48 hours may be provided to allow the fetus’ lungs to mature.<ref name="Haram" /> | In patients diagnosed with HELLP syndrome prior to delivery, the immediate treatment is delivery of the fetus.<ref name="Bacq">Bacq Y. Liver diseases unique to pregnancy: A 2010 update. Clinics and Research in Hepatology and Gastroenterology. 2011; 20: (Article in Press) Available at http://www.sciencedirect.com.libproxy.bellarmine.edu/science?_ob=ArticleListURL&amp;amp;amp;amp;amp;_method=list&amp;amp;amp;amp;amp;_ArticleListID=1651726142&amp;amp;amp;amp;amp;_sort=r&amp;amp;amp;amp;amp;_st=13&amp;amp;amp;amp;amp;view=c&amp;amp;amp;amp;amp;_acct=C000069778&amp;amp;amp;amp;amp;_version=1&amp;amp;amp;amp;amp;_urlVersion=0&amp;amp;amp;amp;amp;_userid=6406088&amp;amp;amp;amp;amp;md5=a96535ccc1419c813a4019495931cad1&amp;amp;amp;amp;amp;searchtype=a. Accessed 22 February 2011.</ref> If the fetus is earlier than 34 weeks gestation, steroid injections and close monitoring for 24-48 hours may be provided to allow the fetus’ lungs to mature.<ref name="Haram" /> | ||
[[Image: | [[Image:HELLP Chart.gif|frame|center|Figure: Suggested protocol in treating pts with HELLP Syndrome]] | ||
[Chart courtesy of Journal of The American Family Physician: [http://www.aafp.org/afp/990901ap/829.html HELLP Syndrome]]<br> | [Chart courtesy of Journal of The American Family Physician: [http://www.aafp.org/afp/990901ap/829.html HELLP Syndrome]]<br> | ||
Revision as of 19:03, 1 March 2011
Original Editors - Carolyn S. Furdek from Bellarmine University's Pathophysiology of Complex Patient Problems project.
Lead Editors - Your name will be added here if you are a lead editor on this page. Read more.
Definition/Description[edit | edit source]
HELLP syndrome is an acronym for several life-threatening symptoms that occur together in a woman’s pregnancy.
These symptoms are:
- H – hemolysis
- EL – elevated liver enzymes
- LP – low platelet count. [1]
[Image courtesy of The Internet Journal of Anesthesiology]
Prevalence[edit | edit source]
As of Nov 2010, HELLP syndrome occurred in 1-2 of every 1000 pregnancies and in 10-20% of women experiencing severe preeclampsia.[1]
Characteristics/Clinical Presentation[edit | edit source]
Approximately 7 out of 10 patients with HELLP syndrome will experience the symptoms prior to delivery between the 27th and 37th week of gestation. The remaining patients will develop the symptoms within 48 hours postpartum.[2]
There are two classifications of HELLP Syndrome:[3]
- Classification 1: Basis of 3 classic lab values
- Partial: one/two of the classic values present
- Full: all three abnormalities present
(Full HELLP syndrome classifications have a higher should be delivered within 48 hours)
- Classification 2: Basis of platlet count
- Class 1: Platlet count < 50,000 mm3
- Class 2: Platlet count 50,000-100,000 mm3
- Class 3: Platlet count 100,000-150,000 mm3
(Class 1 pts have a higher maternal morbidity and mortality)
Clinical symptoms of HELLP include discomfort in the upper right quadrant of the abdomen, pain in the epigastric area, vomiting, and nausea.[2] The abdominal discomfort can increase and decrease throughout the day.[4] Patients can report extreme fatigue prior to presentation or ‘feeling unwell’.[4][1] Other symptoms include headache, fluid retention, excess weight gain, blurry vision, nosebleeds (or bleeding that does not stop easily), seizures/convulsions.[1]
Associated Co-morbidities[edit | edit source]
HELLP syndrome can lead patients to be at a higher risk for the following conditions:[5][6]
- Renal Failure
Renal failure is the loss of the kidney’s ability to function properly. The body will no longer be capable of filtering excess fluid, waste, and salts from the blood. This leads to dangerous levels in the system.[7]
- Consumptive coagulopathy
- Abruptio placentae
- Pulmonary edema
- Cerebral edema
- Subcapsular liver hematoma
- Hypovolemic shock
- Medications
Diagnostic Tests/Lab Tests/Lab Values[edit | edit source]
Lab Tests and Values:[3]
Hemolysis:
(if Hematocrit normal: decreased serum xx levels may be present indicating HELLP)
Liver Enzymes: As high as 4,000 U per L
Platelets: As low as 6,000 per mm3 (anything less than 150,000 per mm3 should be of concern)
Plasma fibrogen: levels less than 300 mg per dL (DIC suspected)
Etiology/Causes[edit | edit source]
add text here
Systemic Involvement[edit | edit source]
add text here
Medical Management (current best evidence)[edit | edit source]
In patients diagnosed with HELLP syndrome prior to delivery, the immediate treatment is delivery of the fetus.[8] If the fetus is earlier than 34 weeks gestation, steroid injections and close monitoring for 24-48 hours may be provided to allow the fetus’ lungs to mature.[2]
[Chart courtesy of Journal of The American Family Physician: HELLP Syndrome]
Physical Therapy Management (current best evidence)[edit | edit source]
add text here
Alternative/Holistic Management (current best evidence)[edit | edit source]
add text here
Differential Diagnosis[edit | edit source]
add text here
Case Reports/ Case Studies[edit | edit source]
add links to case studies here (case studies should be added on new pages using the case study template)
Resources
[edit | edit source]
add appropriate resources here
Recent Related Research (from Pubmed)[edit | edit source]
Failed to load RSS feed from http://eutils.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=12Su8VomptfJPpE_rTFsJEzX3BaJXtAe95ks9RBwz0MZBjlEnU|charset=UTF-8|short|max=10: Error parsing XML for RSS
References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 PubMed Health website. HELLP syndrome. Available at http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001892. Accessed February 18, 2011.
- ↑ 2.0 2.1 2.2 Haram, K. Svendsen, E. Abildgaard, U. The HELLP syndrome: Clinical issues and management. A Review. BMC Pregnancy Childbirth [serial online]. 2009; 9:8.
- ↑ 3.0 3.1 Padden MO. HELLP Syndrome: Recognition and Perinatal Management. American Family Physician. September 1999. Available online at http://www.aafp.org/afp/990901ap/829.html. Accessed 1 March 2011.
- ↑ 4.0 4.1 Sibai BM. Diagnosis, controversies, and management of the syndrome of hemolysis, elevated liver enzymes, and low platelet count. Obstetrics and Gynecology [serial online]. 2004;103:981–991.
- ↑ Svenningsen R, Morken NH, Kahn JA. Corticosteroids in the treatment of HELLP-syndrome? Tidsskr Nor Laegeforen. 2006;126(17):2253–2256.
- ↑ Vigil-De Gracia PE, Tenorio-Marañón RF, Cejudo-Carranza E, Helguera-Martinez A, García-Cáceres E. Difference between pre-eclampsia, HELLP syndrome and eclampsia, maternal evaluation. Ginecol Obstet Mex. 1996;64:337–382.
- ↑ Mayo Clinic web site. Acute Kidney Failure. Available at: http://www.mayoclinic.com/health/kidney-failure/DS00280. Accessed February 22, 2011.
- ↑ Bacq Y. Liver diseases unique to pregnancy: A 2010 update. Clinics and Research in Hepatology and Gastroenterology. 2011; 20: (Article in Press) Available at http://www.sciencedirect.com.libproxy.bellarmine.edu/science?_ob=ArticleListURL&amp;amp;amp;amp;_method=list&amp;amp;amp;amp;_ArticleListID=1651726142&amp;amp;amp;amp;_sort=r&amp;amp;amp;amp;_st=13&amp;amp;amp;amp;view=c&amp;amp;amp;amp;_acct=C000069778&amp;amp;amp;amp;_version=1&amp;amp;amp;amp;_urlVersion=0&amp;amp;amp;amp;_userid=6406088&amp;amp;amp;amp;md5=a96535ccc1419c813a4019495931cad1&amp;amp;amp;amp;searchtype=a. Accessed 22 February 2011.
