scholarly journals An Unusual Presentation of Partial Hemolysis, Elevated Liver Enzyme Levels, and Low Platelet Levels Syndrome in a Case of in vitro Fertilization-DEM Pregnancy

2016 ◽  
Vol 7 (2) ◽  
pp. 73-75
Author(s):  
Nupur Garg ◽  
Revathi Govind ◽  
Smitha Avula
Keyword(s):  
Liver Enzyme ◽  
Lupus Erythematosus ◽  
Hellp Syndrome ◽  
Elevated Liver Enzyme ◽  
Unusual Presentation ◽  
Retroperitoneal Hemorrhage ◽  
Increased Risk ◽  
Autoimmune Conditions ◽  
Donor Embryo

ABSTRACT Pregnancy in women with systemic lupus erythematosus (SLE) or autoimmune conditions is complicated by complementmediated injury and is associated with increased risk of preeclampsia. Immunological intolerance between the mother and the fetus may play an important role in the pathogenesis of preeclampsia. The present case highlights the influence of susceptibility to preeclampsia/hemolysis, elevated liver enzyme levels, and low platelet levels (HELLP) syndrome due to preexisting autoimmune conditions. In vitro fertilization (IVF)- Donor embryo pregnancy (DEM) pregnancy is one such unique scenario where there exists partial immunological disparity between the native intrauterine environment and the implanted donor embryo that could predispose to autoimmune problems in pregnancy. This case illustrates a similar scenario in which a pregnant woman with IVF-DEM conception and antinuclear antibody (ANA) positive status manifested with a normotensive partial HELLP syndrome which was reiterated by the fact that there was clinical evidence of retroperitoneal hemorrhage intraoperatively during cesarean along with the neonate who was diagnosed to have L-carnitine deficiency, which is unique to fetuses with mothers of HELLP syndrome. How to cite this article Garg N, Govind R, Avula S, Rao KA. An Unusual Presentation of Partial Hemolysis, Elevated Liver Enzyme Levels, and Low Platelet Levels Syndrome in a Case of in vitro Fertilization-DEM Pregnancy. Int J Infertil Fetal Med 2016;7(2):73-75.

Thrombin Generation Measured Ex Vivo Following Microvasculor Injury Is Increased in SLE Patients with Antiphospholipid-protein Antibodies

1997 ◽  
Vol 78 (04) ◽  
pp. 1173-1177 ◽  
Author(s):  
Jacek Musiał ◽  
Jakub Swadźba ◽  
Miłosz Jankowski ◽  
Marek Grzywacz ◽  
Stanisława Bazan-Socha ◽  
...  
Keyword(s):  
Lupus Erythematosus ◽  
Thrombin Generation ◽  
Ex Vivo ◽  
Skin Incision ◽  
Anticardiolipin Antibodies ◽  
Small Blood Vessel ◽  
Anionic Phospholipids ◽  
Increased Risk ◽  
High Concentrations

SummaryAntiphospholipid-protein antibodies (APA) include lupus-type anticoagulant (LA) and antibodies recognizing complexes of anionic phospholipids (e.g. cardiolipin) and proteins (e.g. prothrombin and (β2-glycoprotein I). The presence of APA is associated with an increased risk of both arterial and venous thrombosis. However, the pathogenic mechanism leading to thrombosis in patients with APA remains unclear. We studied 32 patients with systemic lupus erythematosus (SLE) who were divided into two groups depending on the presence (n = 19) or absence (n = 13) of APA. Healthy volunteers (n = 12) matched by age and sex served as controls. In all subjects LA and IgG class anticardiolipin antibodies (ACA) were determined. Thrombin generation was monitored ex vivo measuring fibrinopeptide A (FPA) and prothrombin fragment F1 + 2 (F1 + 2) in blood emerging from a skin microvasculature injury, collected at 30 second intervals. In subjects with antiphospholipid antibodies mean FPA and F1 + 2 concentrations were signiF1cantly higher at most blood sampling times than in controls. In some SLE patients with APA the process of thrombin generation was clearly disturbed and very high concentrations of F1brinopeptide A were detected already in the F1rst samples collected. Two minutes after skin incision SLE patients without APA produced slightly more FPA, but not F1 + 2, as compared to healthy subjects. Mathematical model applied to analyze the thrombin generation kinetics revealed that APA patients generated signiF1cantly greater amounts of thrombin than healthy controls (p = 0.02 for either marker). In contrast, in the same patients generation of thrombin in recalciF1ed plasma in vitro was delayed pointing to the role of endothelium in the phenomenon studied. In summary, these data show for the F1rst time that in SLE patients with antiphospholipid-protein antibodies thrombin generation after small blood vessel injury is markedly increased. Enhanced thrombin generation might explain thrombotic tendency observed in these patients.

scholarly journals Kikuchi-Fujimoto disease: unusual presentation of rare disease

2016 ◽  
Vol 6 (1) ◽  
Author(s):  
Duy Vu ◽  
Srini Reddy ◽  
Lynn Day ◽  
Nail Aydin ◽  
Subhasis Misra
Keyword(s):  
Lupus Erythematosus ◽  
Unusual Presentation ◽  
Chronic Infections ◽  
Young Females ◽  
Inappropriate Treatment ◽  
Increased Risk ◽  
Long Term Follow Up ◽  
Autoimmune Processes

Kikuchi-Fujimoto disease (KFD) is a rare, benign disorder that typically follows a selflimiting natural course and was initially described in young females of Asian descent. Its clinical presentation may mimic lymphoproliferative disorders, connective tissue disorders, and chronic infections. This often leads to misdiagnosis and inappropriate treatment. The exact cause of this condition remains unknown although autoimmune processes and certain infectious agents have been associated with the disease. The diagnosis of KFD is made histopathologically. Treatment is supportive and long-term follow-up is recommended due to increased risk of future development of systemic lupus erythematosus. Here we are presenting a case of a patient with an unusual presentation of KFD.

Alpha hemoglobin stabilizing protein (AHSP) in hemolysis elevated liver enzyme and low platelet (HELLP) syndrome, intrauterine growth restriction (IUGR) and fetal death

2005 ◽  
Vol preprint (2007) ◽  
pp. 1
Author(s):  
Monica Emanuelli ◽  
Davide Sartini ◽  
Valentina Rossi ◽  
Alessandra Corradetti ◽  
Beatrice Landi ◽  
...  
Keyword(s):  
Liver Enzyme ◽  
Intrauterine Growth Restriction ◽  
Hellp Syndrome ◽  
Fetal Death ◽  
Elevated Liver Enzyme ◽  
Growth Restriction ◽  
Intrauterine Growth

scholarly journals Eklampsia dan Sindroma HELLP pada Kehamilan Awal: Penegakan Diagnosis dan Manajemen Anestesia

2020 ◽  
Vol 1 (1) ◽  
pp. 40-6
Author(s):  
Fahmi Agnesha ◽  
Sri Rahardjo
Keyword(s):  
Liver Enzyme ◽  
Hellp Syndrome ◽  
Maternal Morbidity ◽  
Fetal Death ◽  
Elevated Liver Enzyme ◽  
Clinical Manifestations ◽  
Morbidity And Mortality ◽  
Anesthesia Management ◽  
Maternal Morbidity And Mortality ◽  
Severity Of The Disease

Preeklampsia merupakan salah satu penyebab morbiditas dan mortalitas ibu hingga saat ini. Penyakit ini memiliki beberapa bentuk manifestasi klinis yang merupakan gambaran dari perburukan dari preeklampsia diantaranya adalah eklampsia dan sindroma HELLP (hemolysis, elevated liver enzyme dan low platelet). Kedua perburukan preeklampsia tersebut biasa terjadi pada usia kehamilan 27 hingga 37 minggu, namun semakin dini onset penyakit ini muncul prognosis bagi ibu akan semakin buruk. Seorang perempuan usia 34 tahun, gravida 3 paritas 1 abortus 1 hamil 24 minggu, janin intra uterine fetal death. Pasien datang dikarenakan kejang seluruh badan selama 5 menit sekitar 30 menit yang lalu sebelum masuk rumah sakit. Berdasarkan pemeriksaan fisik didapatkan hipertensi dengan tekanan darah 180/110 mmHg. Selain itu dari pemeriksaan penunjang didapatkan trombositopenia 94.000, SGOT 350 IU/L and SGPT 285 IU/L. Pasien didiagnosis dengan eklampsia dan sindroma HELLP, kemudian dilakukan terminasi kehamilan melalui seksio sesarea darurat dengan anestesia umum. Pembahasan: manajemen anestesia pada ibu hamil dengan eklampsia dan sindroma HELLP memiliki beberapa pertimbangan khusus antara lain adanya kesulitan intubasi, kemungkinan terjadinya peningkatan tekanan intrakranial dan juga efek pemberian anti kejang terhadap kontraksi rahim. Melalui penegakan diagnosis dan pengenalan risiko yang mungkin dapat terjadi pada pasien dengan eklampsia dan sindroma HELLP dapat direncanakan tindakan dan manajemen anestesia yang lebih baik sehingga morbiditas dan mortalitas ibu dengan eklampsia dan sindroma HELLP dapat diturunkan.   Eclampsia and HELLP Syndrome in Early Pregnancy: Diagnosis and Management of Anesthesia Abstract Preeclampsia is one of the leading cause maternal morbidity and mortality. It has various clinical manifestations that describe the severity of the disease include eclampsia and HELLP syndrome (hemolysis, elevated liver enzyme dan low platelet). Those worsening of preeclampsia usually happen during 27 to 37 weeks of gestation. Even though the earlier the onset showed the worse the prognosis is. A pregnant woman 34 years old, gravidy 3 parity 1 abortus 1, 24 weeks gestational age with intra uterine fetal death. Patient had chief complain for seizure before admission. From the physical examination found that patient has severe hypertension with blood pressure 180/110 mmHg. The laboratory result showed trombositopenia 94.000, SGOT 350 IU/L and SGPT 285 IU/L. Patient diagnosed with eclampsia and HELLP syndrome and then did emergency caesarean section with general anesthesia. Discussion: The anesthesia management in this case should be specifics due to the patient condition circumstances with eclampsia and HELLP syndrome. We should prepare for difficult airway, intracranial pressure increase and effect of anticonvulsant agent to the uterine tone. By diagnose and identify the risk of eclamptic and HELLP syndrome patient carefully we can plan the better procedure and anesthesia management that maternal morbidity and mortality can be reduced.

Pregnancy Outcome in Impaired Liver Function in Pre-eclampsia

2020 ◽  
Vol 49 (2) ◽  
pp. 9-13
Author(s):  
Amina Khatun ◽  
Abul Masud Md Nurul Karim ◽  
Aslam Hossain Biswas ◽  
Md Tarique Mehedi Parvez
Keyword(s):  
Liver Function ◽  
Pregnancy Outcome ◽  
Liver Enzyme ◽  
Hellp Syndrome ◽  
Liver Enzymes ◽  
Elevated Liver Enzyme ◽  
Epigastric Pain ◽  
Clinical Severity ◽  
Third Trimester ◽  
Major Complications

Pre-eclampsia induced liver disease is a disorder unique to pregnancy and is frequently seen in third trimester. Severe pre-eclampsia is defined by extreme elevation in systemic blood pressure and evidence of organ compromise. HELLP syndrome is a unique liver related disorder of pregnancy that was first described by Weinstein in1982 as a constellation of clinical and laboratory abnormalities in pregnant women in their third trimester. This disorder was termed HELLP syndrome with (H) for haemolysis, (EL) for elevated liver enzymes and (LP) for low platelet counts. This is a severe variant of pre-eclampsia. Objective of this study was to determine the alteration of liver function in preeclampsia and its correlation with the clinical severity as well as the perinatal outcome. This was a one-year prospective observational cross sectional study included 100 patients with pre-eclampsia. Severity of the pre-eclampsia clarified clinically. Pre-eclampsia patients having history of hepatitis, cirrhosis of liver, gallbladder diseases and other pre-existing medical disorders that altered liver function were excluded from this study. The mean age of the patients was 25.3+4.9 years ranging from 18 to 37 years. One third of the patients (33.3%) were in the age group 28 to 32 years. Out of 100 patients, 58% belongs to poor income group. Among the studied samples 17% had epigastric pain and discomfort, 13% had complaints of vomiting and 43% develop severe pre-eclampsia. Among the Patients with altered hepatic enzyme level, 8.33% had complaints of epigastric pain, 6.66% complains vomiting. Maximum patients (66.6%) with elevated liver enzyme had no major complications whereas 33.4% of patients developed major complications. Patients with severe pre-eclampsia have elevated liver enzyme whereas patients of mild symptoms had normal liver enzymes level. Cases with raised serum biochemical markers had strong association with complications of severe pre-eclampsia. Pregnancy outcome in severe pre-eclampsia with hepatic involvement is grievous. Graves sequlae of pre-eclampsia can be prevented and minimized by timely institutional intervention. Post-partum followup would help to find out other parameters of pregnancy outcome. Bangladesh Med J. 2020 May; 49(2) : 9-13

scholarly journals Delayed Diagnosis of Colonic Adenocarcinoma in a 30-Year-Old Postpartum Woman Misdiagnosed with HELLP Syndrome

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Alexander J. Maqueira ◽  
Ahmad O. Rifai ◽  
Courtney Albury ◽  
William A. Kantrales ◽  
David Rydell ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Liver Enzyme ◽  
Hellp Syndrome ◽  
Elevated Liver Enzyme ◽  
Delayed Diagnosis ◽  
Hepatic Metastases ◽  
Postpartum Woman ◽  
Intrauterine Pregnancy ◽  
Persistent Symptoms ◽  
Elevated Liver Enzymes

Colon cancer is a rare diagnosis in 30-year-old women, which may be further complicated by their concurrent gravid status. Several physiological changes that occur during an intrauterine pregnancy (IUP) can mask symptoms of early colon cancer. Our patient was a 30-year-old, Gravida 2, Para 0 woman with an uncomplicated pregnancy until the 35th week of gestation when she developed preeclampsia and symptoms suggestive of early hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome. Following induction of labor and the subsequent, uncomplicated vaginal delivery, the patient developed symptoms of nausea, vomiting, and constipation with abdominal pain and bloating. Abdominal computed tomography (CT) revealed a large mass in the right colon along with the involvement of periaortic lymph nodes and the presence of liver metastases. Hepatic metastases were possibly responsible for the patient’s elevated liver enzyme levels, which were initially considered to have been caused by HELLP syndrome because the patient also had preeclampsia. The rarity of colon cancer in young, pregnant patients with no family history, such as in this case, results in poor prognosis owing to nonspecific symptoms of the developing malignancy being attributed to pregnancy, which further delays diagnosis and subsequent therapy. Of 29 cases of colon cancer in pregnant patients recorded till date, this is the first report of a stage 4 adenocarcinoma of the colon with hepatic metastasis, elevated liver enzyme levels, and increased blood pressure with associated preeclampsia, which was diagnosed in the postpartum period. It may be important to consider broader differential diagnoses in expectant patients presenting with unusual and persistent symptoms.

scholarly journals Emergency LSCS in a Parturient with Pre-eclampsia and HELLP Syndrome with Altered Renal Functions Managed with Regional Anaesthesia

2021 ◽  
Author(s):  
Pooja Arpan Shah ◽  
Mehul Mehta ◽  
Jatin Patel
Keyword(s):  
Liver Enzyme ◽  
Hellp Syndrome ◽  
Regional Anaesthesia ◽  
Blood Smear ◽  
Elevated Liver Enzyme ◽  
Peripheral Blood Smear ◽  
Anaesthetic Management ◽  
Advanced Stage ◽  
Renal Functions ◽  
Pedal Oedema

Haemolysis, Elevated Liver enzyme levels, and Low Platelet (HELLP) syndrome is characterised by haemolysis (abnormal peripheral blood smear, increased unconjugated bilirubin), elevated liver enzyme and decreased platelet count. It is an advanced stage of pre-eclampsia. Pre-eclampsia is defined as blood pressure >140/90 mmHg with proteinuria with or without pedal oedema. HELLP syndrome account for 24% of maternal mortality and 40% of perinatal mortality. Anaesthetic management of such parturient is also challenging. This report is about a 35-year-old female patient with HELLP syndrome and altered renal function requiring LSCS. She was managed with regional anaesthesia.

Atherosclerosis and cardiovascular disease in systemic lupus erythematosus: effects of in vivo statin treatment

2014 ◽  
Vol 74 (7) ◽  
pp. 1450-1458 ◽  
Author(s):  
Patricia Ruiz-Limon ◽  
Nuria Barbarroja ◽  
Carlos Perez-Sanchez ◽  
Maria Angeles Aguirre ◽  
Maria Laura Bertolaccini ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Gene Networks ◽  
Mitochondrial Activity ◽  
Systemic Lupus ◽  
Increased Risk ◽  
Fluvastatin Treatment

ObjectiveStatins may have beneficial vascular effects in systemic lupus erythematosus (SLE) beyond their cholesterol-lowering action, although the mechanisms involved are not completely understood. We investigated potential mechanisms involved in the efficacy of fluvastatin in preventing atherothrombosis in SLE.MethodsEighty-five patients with SLE and 62 healthy donors were included in the study. Selected patients (n=27) received 20 mg/day fluvastatin for 1 month. Blood samples were obtained before the start and at the end of treatment. Monocytes from five patients were treated in vitro with fluvastatin.ResultsIncreased prothrombotic and inflammatory variables were found in patients with SLE. SLE monocytes displayed altered mitochondrial membrane potential and increased oxidative stress. Correlation and association analyses demonstrated a complex interplay among autoimmunity, oxidative stress, inflammation and increased risk of atherothrombosis in SLE. Fluvastatin treatment of patients for 1 month reduced the SLE Disease Activity Index and lipid levels, oxidative status and vascular inflammation. Array studies on monocytes demonstrated differential expression in 799 genes after fluvastatin treatment. Novel target genes and pathways modulated by fluvastatin were uncovered, including gene networks involved in cholesterol and lipid metabolism, inflammation, oxidative stress and mitochondrial activity. Electron microscopy analysis showed increased density volume of mitochondria in monocytes from fluvastatin-treated patients, who also displayed higher expression of genes involved in mitochondrial biogenesis. In vitro treatment of SLE monocytes confirmed the results obtained in the in vivo study.ConclusionsOur overall data suggest that fluvastatin improves the impairment of a redox-sensitive pathway involved in processes that collectively orchestrate the pathophysiology of atherothrombosis in SLE.

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