Case of Complicated Fatty Liver of Pregnancy With Good Outcome

Acute fatty liver of pregnancy (AFLP) is a rare condition with an incidence rate of 1 to 20 000 that mostly occurs in the third trimester of pregnancy. There is no specific treatment for AFLP thus a conservative treatment is usually applied in this regard. This case report is related to a 28-year-old G3 P1 Ab1 L1 woman at 29 weeks of pregnancy who was referred to our emergency ward from a primary setting with an epigastric pain, a mild hypertension, and the suspicion of HELLP [Hemolysis, elevated liver enzymes, and low platelet count] syndrome. The lab exams ruled out viral infections including hepatitis B virus (HBV), hepatitis C virus (HCV), and Human immunodeficiency virus (HIV). In addition, the urine protein was 40 mg/600 cc. AFLP was diagnosed and a cesarean was performed under spinal analgesia because of elevated liver enzymes, proteinuria in the normal range for pregnancy, the presence of viral infections that involved the liver, and lack of pruritus. A 29-week girl with a weight of 1115 g was born and the patient was discharged with a good condition. At 5 days postpartum, she referred with abdominal pain, fever, as well as incisional redness and discharge. The ultrasound scan showed a hematoma in the depth of the subdermis point of the cesarean incision. Thus, antibiotics and one unit of fresh frozen plasma were infused. On 14-day postpartum, the patient was discharged with a good condition. The purpose of this study was to focus the attention of physicians to the point that AFLP may improve after childbirth but it may predispose the patient to coagulation disorders and hematoma.

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Comparison of Maternal and Neonatal Outcomes between Acute Fatty Liver of Pregnancy and Hemolysis, Elevated Liver Enzymes and Low Platelets Syndrome: A Retrospective Cohort Study

10.21203/rs.3.rs-111120/v1 ◽

2020 ◽

Author(s):

Sau Xiong Ang ◽

Chie-Pein Chen ◽

Fang-Ju Sun ◽

Chen-Yu Chen

Keyword(s):

Cohort Study ◽

Fatty Liver ◽

Retrospective Cohort Study ◽

Hellp Syndrome ◽

Retrospective Cohort ◽

Liver Enzymes ◽

Neonatal Outcomes ◽

Elevated Liver Enzymes ◽

Acute Fatty Liver ◽

Maternal And Neonatal Outcomes

Abstract Background: Acute fatty liver of pregnancy (AFLP) and hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome are two uncommon disorders that mimic each other clinically, but are distinct pathophysiologically. This study aimed to compare maternal and neonatal outcomes between AFLP and HELLP syndrome.Methods: This retrospective cohort study was performed at a tertiary referral center in Taiwan between June 2004 and April 2020. We used the Swansea Criteria to diagnose AFLP, and the Tennessee Classification System to diagnose HELLP syndrome. Maternal characteristics, laboratory data, complications, and neonatal outcomes were analyzed.Results: During the study period, 21 women had AFLP and 80 women had HELLP syndrome. There was a higher rate of preeclampsia (95.0% versus 23.8%) in the HELLP syndrome group compared to the AFLP group. However, the AFLP group had more other maternal complications including jaundice (85.7% versus 13.8%), acute kidney injury (61.9% versus 15.0%), disseminated intravascular coagulopathy (66.7% versus 8.8%), and sepsis (47.6% versus 10.0%) compared to the HELLP syndrome group. Nevertheless, higher rates of small for gestational age neonates (57.1% versus 33.3%), neonatal respiratory distress syndrome (39.2% versus 8.3%) and neonatal sepsis (34.2% versus 12.5%) were noted in the HELLP syndrome group.Conclusions: AFLP is associated with a higher rate of multiple organ dysfunction in mothers, whereas HELLP syndrome is associated with a higher rate of neonatal morbidity.

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Congenital Deficiency in Factor VII Revealed by Menorrhagia: Case Report

Asian Journal of Pediatric Research ◽

10.9734/ajpr/2020/v4i130138 ◽

2020 ◽

pp. 1-5

Author(s):

Nadia Mebrouk ◽

Abdelilah Radi ◽

Mohamed Selouti ◽

Amal Hassani ◽

Abdelhakim Ourrai ◽

...

Keyword(s):

Treatment Options ◽

Specific Treatment ◽

Fresh Frozen Plasma ◽

Factor Vii ◽

Activity Measurement ◽

Recombinant Activated Factor Vii ◽

Congenital Deficiency ◽

Activated Factor Vii ◽

Fresh Frozen ◽

Fvii Deficiency

Factor VII (FVII) deficiency is the most common among rare inherited autosomal recessive bleeding disorders. It is a multifaceted disease because of the lack of a direct correlation between plasma levels of coagulation FVII and bleeding manifestations. Clinical phenotypes range from asymptomatic condition—even in homozygous subjects—to severe, life-threatening bleedings (e.g., central nervous system and gastrointestinal bleeding). Menorrhagia is a frequent type of bleeding in FVII deficiency, with a prevalence rate of two in three women aged 10 to 50 years and with a peak prevalence in teenagers. When menorrhagia is observed and once the gynecological causes are excluded, it is important to carry out a hemostasis assessment because, if an anomaly is found, specific treatment can be administered and preventive measures taken. Basic diagnostic work-up includes routine assays, prothrombin level, activated partial thromboplastin time and platelet count, followed by FVII coagulant activity measurement for isolated decreased prothrombin level. To confirm the diagnosis, FVII assay should be repeated at least once. Several treatment options are currently available for FVII deficiency: Recombinant activated Factor VII (rFVIIa), plasma-derived Factor VII, fresh frozen plasma and prothrombin complex concentrates. rFVIIa is the most used replacement therapy. Other medical therapies of menorrhagia includes hemostatic agents and hormonal treatments (combined oral contraceptives, levonorgestrel intrauterine devices), in combination or not with rFVIIa. We report the case of a fourteen-and-a-half-year-old girl who presented menorrhagia of great abundance at the age of thirteen, the exploration of which revealed a congenital deficit in FVII.

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A Case of Massive Hepatic Infarction in a Patient with HELLP Syndrome

American Journal of Perinatology Reports ◽

10.1055/s-0039-1681028 ◽

2019 ◽

Vol 09 (01) ◽

pp. e84-e87

Author(s):

Jessica Morgan ◽

Micaela Della Torre ◽

Anna Whelan ◽

Sophia Rodriguez ◽

Laura DiGiovanni

Keyword(s):

Liver Enzymes ◽

Epigastric Pain ◽

Early Recognition ◽

Rare Complication ◽

Liver Function Tests ◽

True Incidence ◽

Hepatic Infarction ◽

Elevated Liver Enzymes ◽

Blood Pressures ◽

The Right

Background Hepatic infarction is an exceedingly rare complication of hemolysis, elevated liver enzymes, and low platelets syndrome. Few cases have been described in the medical literature and the true incidence remains unknown. It can lead to fulminant liver failure, liver transplant, or death if not promptly addressed. Case Report A 22-year-old primigravida presented with right upper quadrant and epigastric pain at 28 weeks' gestation. She had severely elevated blood pressures requiring intravenous antihypertensives as well as proteinuria, thrombocytopenia, and mild transaminitis. Within 6 hours of admission, her rapidly rising liver function tests (LFTs) necessitated urgent delivery by primary cesarean section. Her liver enzymes continued to rapidly worsen postoperatively and immediate postpartum computed tomography of the abdomen and pelvis revealed massive hepatic infarction, 11 × 10 × 15 cm, of the right lobe of the liver. Her transaminases peaked at alanine transferase of 2,863 IU/L and aspartate transferase of 2,732 IU/L. She received supportive multidisciplinary intensive care, and LFTs returned to normal by postoperative day 20. Conclusion Hepatic infarction is an extraordinarily rare complication of pre-eclampsia. Early recognition and prompt multidisciplinary management are vital to prevent catastrophic bleeding, hepatic failure, and death.

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Increased Risk of Type 2 Diabetes in Subjects with Both Elevated Liver Enzymes and Ultrasonographically Diagnosed Nonalcoholic Fatty Liver Disease: A 4-year Longitudinal Study

Archives of Medical Research ◽

10.1016/j.arcmed.2013.01.007 ◽

2013 ◽

Vol 44 (2) ◽

pp. 115-120 ◽

Cited By ~ 37

Author(s):

Ji Hun Choi ◽

Eun Jung Rhee ◽

Ji Cheol Bae ◽

Se Eun Park ◽

Cheol Young Park ◽

...

Keyword(s):

Type 2 Diabetes ◽

Liver Disease ◽

Longitudinal Study ◽

Fatty Liver ◽

Fatty Liver Disease ◽

Liver Enzymes ◽

Nonalcoholic Fatty Liver ◽

Elevated Liver Enzymes ◽

Increased Risk

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Differentiation of acute fatty liver of pregnancy from syndrome of hemolysis, elevated liver enzymes and low platelet counts

Journal of Obstetrics and Gynaecology Research ◽

10.1111/jog.12282 ◽

2014 ◽

Vol 40 (3) ◽

pp. 641-649 ◽

Cited By ~ 34

Author(s):

Hisanori Minakami ◽

Mamoru Morikawa ◽

Takahiro Yamada ◽

Takashi Yamada ◽

Rina Akaishi ◽

...

Keyword(s):

Fatty Liver ◽

Liver Enzymes ◽

Platelet Counts ◽

Elevated Liver Enzymes ◽

Acute Fatty Liver

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Challenges in Screening for Pediatric Nonalcoholic Fatty Liver Disease

Clinical Pediatrics ◽

10.1177/0009922817733300 ◽

2017 ◽

Vol 57 (5) ◽

pp. 558-562 ◽

Cited By ~ 1

Author(s):

Anna E. Ferguson ◽

Stavra A. Xanthakos ◽

Robert M. Siegel

Keyword(s):

Liver Disease ◽

Fatty Liver ◽

Weight Management ◽

Fatty Liver Disease ◽

Liver Enzymes ◽

Management Program ◽

Weight Management Program ◽

Nonalcoholic Fatty Liver ◽

Elevated Liver Enzymes ◽

Pediatric Weight Management

Nonalcoholic fatty liver disease (NAFLD) is the most common cause of elevated liver enzymes in children in the United States. Screening for NAFLD in children with obesity is recommended by several published guidelines, but the application of these recommendations in pediatric weight management programs is uncertain. Our study aimed to describe the screening practices for NAFLD in a large pediatric weight management program. During 2014, 1312 patients were seen, with a liver enzyme panel obtained in 847 (64.5%). Only 47/847 (5.5%) had elevated liver enzymes twice the upper limit of normal. Of the 47, 33 (70%) patients had persistently elevated liver enzymes. Of those 33, 22 (67%) had further exclusionary laboratory testing. Screening for NAFLD is challenging even in a pediatric weight management program with clearly established protocols. Those with elevated liver enzymes do not always complete recommended exclusionary testing. Barriers to completing further evaluation need to be addressed.

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Benefits of exenatide on obesity and non-alcoholic fatty liver disease with elevated liver enzymes in patients with type 2 diabetes

Diabetes/Metabolism Research and Reviews ◽

10.1002/dmrr.2561 ◽

2014 ◽

Vol 30 (6) ◽

pp. 521-529 ◽

Cited By ~ 79

Author(s):

Ning Shao ◽

Hong Yu Kuang ◽

Ming Hao ◽

Xin Yuan Gao ◽

Wen Jian Lin ◽

...

Keyword(s):

Type 2 Diabetes ◽

Liver Disease ◽

Fatty Liver ◽

Fatty Liver Disease ◽

Liver Enzymes ◽

Alcoholic Fatty Liver ◽

Elevated Liver Enzymes ◽

Alcoholic Fatty Liver Disease

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Spontaneous Subarachnoid Hemorrhage Associated with the Use of Warfarin

JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA ◽

10.22290/jbnc.v26i2.1321 ◽

2018 ◽

Vol 26 (2) ◽

pp. 145-147

Author(s):

Linoel Curado Valsechi ◽

Lucas Crociati Meguins ◽

Dionei Freitas De Morais ◽

Antônio Ronaldo Spott

Keyword(s):

Subarachnoid Hemorrhage ◽

Oral Anticoagulants ◽

Rare Event ◽

Rare Condition ◽

International Normalized Ratio ◽

Fresh Frozen Plasma ◽

The Body ◽

Neck Stiffness ◽

Fresh Frozen ◽

The Right

Introduction: The most common cause of Subarachnoid Hemorrhage (SAH) is trauma and among spontaneous causes the rupture of intracranial aneurysms represents about 75 to 80%. The association between SAH and use of warfarin is a rare condition. Case Report: Female, 50 years, submitted to valvuloplasty surgery on May 2011, and in use of Warfarin since then, presented after one year with a severe headache, describing it as “the worst of her life”, associated to paresis in the left side of the body. Admited to the hospital in GCS 15 with neck stiffness due to hemiparesia in the left side and nasolabial sulcus shift to the right. The head CT (computed tomography) showed SAH Fisher II, without sign of ischemia. The international normalized ratio (INR) was 10. AngioCT did not show aneurism. The patient was taken to ICU, anticoagulant was suspended, the INR was corrected with fresh plasma, and K vitamin and neuroprotective measures were taken. After one month of hospitalization the patient had medical discharge in GCS 15, asymptomatic, with normalized INR and reintroduction of Warfarin. Conclusion: Intracranial hemorrhage associated to the use of oral anticoagulants is the leading cause of death in these patients. However, among them the isolated SAH is a rare event and therefore with few reports in the literature. The INR reversal therapy with the use of prothrombin concentrate, fresh frozen plasma and vitamin K have been adopted in the approach of these patients.

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