Emergency medical services bring a primigravid patient at weeks gestation to the obstetric triage unit after she developed acute, severe right upper quadrant abdominal pain and recurrent vomiting. Her blood pressure is mm Hg, and her pulse is /min. Physical examination demonstrates marked tenderness just below the right costal margin. Laboratory studies reveal the following:
| Test | Result | Reference Range |
|---|---|---|
| Hemoglobin | g/dL | g/dL |
| Platelets | /mm³ | /mm³ |
| Aspartate aminotransferase (AST) | U/L | U/L |
| Alanine aminotransferase (ALT) | U/L | U/L |
| Total bilirubin | mg/dL | mg/dL |
| Prothrombin time (PT) | sec | sec |
| Activated partial thromboplastin time (aPTT) | sec | sec |
| Fibrinogen | mg/dL | mg/dL (in pregnancy) |
A peripheral blood smear demonstrates numerous schistocytes.
Based on the interpretation of these laboratory results, which of the following is the most likely diagnosis?
- AAcute fatty liver of pregnancy
- BDisseminated intravascular coagulation
- HELLP syndromeCevap
- DImmune thrombocytopenia
- EThrombotic thrombocytopenic purpura
Cevap
HELLP syndrome
The correct answer accurately identifies HELLP syndrome, which is defined by the triad of Hemolysis (evidenced by anemia, schistocytes, and elevated bilirubin), Elevated Liver enzymes (transaminitis), and Low Platelets. A critical distinguishing factor in interpreting laboratory results for HELLP is that, unlike disseminated intravascular coagulation (DIC) or acute fatty liver of pregnancy (AFLP), the coagulation studies (PT, aPTT, and fibrinogen) remain completely normal until catastrophic complications (such as liver rupture or secondary DIC) occur.
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Anahtar Kavram
Distinguishing microangiopathic hemolytic anemias and liver pathologies in pregnancy primarily relies on interpreting the coagulation profile (PT, aPTT, fibrinogen) alongside basic metabolic and hematologic markers.
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