Vázquez-Rodríguez JG, Ríos-Gutiérrez CD, Pa redes-Lozano EP, García-Fiores A

Language: Spanish
References: 20
Page: 19-26
PDF size: 2175.46 Kb.

ABSTRACT

Background: HELLP syndrome is an aggressive form of preeclampsia related with hemolysis and its complications.
Objective: To determine the frequency of the appearance of criteria of hemolysis and maternal complications in preeclamptic patients with HELLP syndrome treated in an intensive care unit.
Material and Method: We carried out a cross-sectional study in 50 preeclamptic women with HELLP syndrome admitted to intensive care unit to determine the presence of the following criteria of hemolysis: peripheral blood schistocytes, anemia (hemoglobin ≤10 g/dL), lactate dehydrogenase ≥600 U/L, indirect bilirubin ≥0.6 mg/dL and hemoglobinuria. We also studied maternal complications in patients with lactate dehydrogenase ≥600 U/L and positive for schistocytes. Descriptive (mean, median, range, standard deviation) and inferential (Student t test) statistics were used.
Results: Lactate dehydrogenase ≥600 U/L was found in 36%, indirect bilirubin ≥0.6 mg/dL in 20%, positive schistocytes in 16%, hemoglobinuria in 4% and anemia in 0%. Patients with lactate dehydrogenase ≥600 U/L had more clinical and laboratory deterioration as well as prolonged intensive care unit stay (p=0.0025). Patients positive for schistocytes did not demonstrate adverse effects.
Conclusions: Biochemical criteria of hemolysis were more frequent than schistocytes, hemoglobinuria and anemia. Patients with lactate dehydrogenase ≥600 U/L was alterations more serious than patients with positive schistocytes so its usefulness as a biomarker may be higher.

REFERENCES

1. Pritchard JA, Ratnoff OD, Wesisman R Jr. Hemostatic defects and increased red cell destruction in pre-eclampsia and eclampsia. Obstet Gynecol.1954;2:159-164.

2. López-Llera MM, Espinosa MM, Díaz de León PM, Rubio LC. Abnormal coagulation and fibrinolysis in eclampsia. Am J Obstet Gynecol.1976;124:681-687.

3. Díaz de León PM, Vargas SLB, Espinosa MM, Martínez GM. Insuficiencia renal aguda, anemia hemolítica y trombocitopenia en toxemia del embarazo. Nefrol Mex.1981;1:5-12.

4. Espinosa MM, Díaz de León PM, Yáñez MI, Neniger CHJH, Colmenares MI. Microangiopatía trombótica y hemólisis intravascular en la toxemia. Rev Med Inst Mex Seguro Soc.1982;20:35-41.

5. Weinstein L. Syndrome of hemolysis, elevated liver enzymes, and low platelet count: a severe consequence of hypertension in pregnancy. Am J Obstet Gynecol. 1982;142:159-167.

6. Sibai BM. The HELLP syndrome (hemolysis, elevated liver enzymes and low platelets): much ado about nothing? Am J Obstet Gynecol.1990;62:311-316.

7. Martin JN Jr, Blake PG, Lowry SL, Perry KG Jr, Files JC, Morrison JC. Pregnancy complicated by preeclampsia-eclampsia with the syndrome of hemolysis, elevated liver enzymes, and low platelet count: how rapid is postpartum recovery? Obstet Gynecol.1990;76:737-741.

8. Curiel-Balsera E, Prieto-Palomino MA, Muñoz-Bono J, Ruiz de Elvira MJ, Galeas JL, Quesada García G. Analysis of maternal morbidity and mortality among patients admitted to obstetric intensive care with severe preeclampsia, eclampsia or HELLP syndrome. Med Intensiva.2011;35(8):478-483.

9. Mihu D, Costin N, Mihu CM, Seicean A, Ciortea R: HELLP syndrome -a multisystemic disorder. J Gastrointestin Liver Dis.2007;16:419-424.

10. Duarte-Mote J, Espinosa-López RF, Romero-Figueroa S, Lee Eng-Castro VE, Verduzco-Pineda J, Calvo-Colindres J, et.al. Microangiopatía en la preeclampsia: utilidad del frotis de sangre periférica. Rev Med Inst Mex Seguro Soc. 2012;50(5): 511-516.

11. Briones-Garduño JC, Herrera-Villalobos JE. Presencia del equinocito en el síndrome de preeclampsiaeclampsia ¿Manifestación subclínica del síndrome? Cir Cir.2003;71(6):455-459.

12. Briones-Garduño JC, Díaz de León-Ponce M, Gómez Bravo-Topete E, Ávila-Esquivel F, Ochoa Ruiz-Esparza C, Briones-Vega CG, et al. Medición de fuga capilar en la preeclampsia-eclampsia. Cir Cir.2000;68(5):194-197.

13. Gómez Bravo-Topete E, Briones-Garduño JC, Díaz de León-Ponce M, Ávila-Esquivel F, Briones-Vega CG. Frotis de sangre periférica y alteración orgánica en la preeclampsiaeclampsia. Cir Cir. 2000;68(4):159-163.

14. Davidge ST. Oxidative stress and altered endothelial cell function in preeclampsia. Semin Reprod Endocrinol. 1998;16(1):65-73.

15. Von Dadelszen P, Menzies J, Payne B, Magee L. Predicting adverse outcomes in women with severe pre-eclampsia. Semin Perinatol.2009;33:152-157.

16. Sankaralingam S, Arenas IA, Lalu MM, Davidge ST. Preeclampsia: current understanding of the molecular basis of vascular dysfunction. Expert Rev Mol Med. 2006;8(3):1- 20.

17. Dekker GA, Sibai BM, Etiology and pathogenesis of preeclampsia. Current concepts. Am J Obstet Gynecol. 1998;179(5):1359-1375.

18. Gómez Bravo-Topete E, Morales-Esquivel JG, Briones- Vega CG. Dímero D en preeclampsia-eclampsia. Cir Cir. 2002;70(2):98-101.

19. Verduzco RL, González PE, Manffrini MF, López AB. Dímero D en diferentes etapas de la toxemia del embarazo. Estudio piloto. Ginecol Obstet Mex.1998; 66(2):77-80.

20. Jaiswar SP, Gupta A, Sachan R, Natu SN, Shaili M. Lactic dehydrogenase: a biochemical marker for preeclampsiaeclampsia. J Obstet Gynaecol India.2011;61(6);645-648.