Match each of the following peripartum or postpartum patient presentations with the most accurate diagnosis. Select the condition that best explains the unique combination of clinical timing and laboratory findings.
- A 30-year-old G1P0 at 36 weeks gestation presents with a 2-day history of continuous nausea, vomiting, and right upper quadrant pain. Blood pressure is 150/90 mmHg. Laboratory findings show a platelet count of 85,000/µL, glucose of 42 mg/dL, AST 250 U/L, ALT 220 U/L, prolonged prothrombin time, and fibrinogen of 110 mg/dL (normal pregnancy: 300-600 mg/dL).Acute fatty liver of pregnancy (AFLP)
- A 27-year-old G2P1 at 37 weeks gestation complains of right upper quadrant pain and blurred vision. Blood pressure is 165/105 mmHg. Laboratory analysis shows a platelet count of 55,000/µL, glucose 95 mg/dL, AST 450 U/L, ALT 480 U/L, normal prothrombin time, and fibrinogen of 400 mg/dL. A peripheral blood smear reveals schistocytes.HELLP syndrome
- A 24-year-old woman, 8 days postpartum following an uncomplicated vaginal delivery, is evaluated for confusion and new-onset petechiae. Blood pressure is 125/80 mmHg. Labs reveal a platelet count of 15,000/µL, hemoglobin 7.5 g/dL with schistocytes, creatinine 1.3 mg/dL, normal AST/ALT, and normal prothrombin time.Thrombotic thrombocytopenic purpura (TTP)
- A 33-year-old woman, 3 weeks postpartum, presents with severe fatigue and reduced urine output. Blood pressure is 175/110 mmHg. Labs show a platelet count of 80,000/µL, hemoglobin 8.2 g/dL with schistocytes, creatinine 4.8 mg/dL, normal AST/ALT, normal prothrombin time, and normal ADAMTS13 activity.Complement-mediated hemolytic uremic syndrome (aHUS)
Cevap
Patient 1 matches Acute fatty liver of pregnancy (AFLP); Patient 2 matches HELLP syndrome; Patient 3 matches Thrombotic thrombocytopenic purpura (TTP); Patient 4 matches Complement-mediated hemolytic uremic syndrome (aHUS).
The correct matches require distinguishing conditions with overlapping features of thrombocytopenia, hemolysis, and organ dysfunction in pregnancy. Acute fatty liver of pregnancy (AFLP) is identified by signs of frank liver synthetic failure (hypoglycemia, coagulopathy). HELLP syndrome features hemolysis, elevated liver enzymes, and low platelets but preserves liver synthetic function (normal PT/PTT and glucose). TTP is triggered postpartum and causes severe thrombocytopenia and neurological symptoms due to ADAMTS13 deficiency, while aHUS presents postpartum with predominant, severe acute kidney injury due to alternative complement pathway dysregulation.
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Anahtar Kavram
Differential diagnosis of pregnancy-associated thrombotic microangiopathies and liver dysfunction requires analyzing the timing of presentation (antepartum vs. postpartum) and identifying specific end-organ damage patterns, particularly hepatic synthetic failure (AFLP) and severity of renal versus neurological involvement (aHUS vs. TTP).
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