Differentiating Hemolysis, Elevated Liver Enzymes, and Low Platelet Count Syndrome and Atypical Hemolytic Uremic Syndrome in the Postpartum Period
Pregnancy-associated atypical hemolytic uremic syndrome (aHUS) is a life-threatening thrombotic microangiopathy which may be mistaken for hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. We sought to identify laboratory parameters that differentiate aHUS and HELLP syndrome...
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Published in | Hypertension (Dallas, Tex. 1979) Vol. 78; no. 3; pp. 760 - 768 |
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Main Authors | , , , |
Format | Journal Article |
Language | English |
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United States
Lippincott Williams & Wilkins
01.09.2021
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Abstract | Pregnancy-associated atypical hemolytic uremic syndrome (aHUS) is a life-threatening thrombotic microangiopathy which may be mistaken for hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. We sought to identify laboratory parameters that differentiate aHUS and HELLP syndrome in the postpartum period. PubMed was searched from inception to March 2018 to identify cases of aHUS in the postpartum period, while cases of HELLP syndrome were identified from a cohort of deliveries at our institution from January 2015 to December 2018. Postpartum laboratory data were abstracted as either peak values (AST [aspartate transaminase]; creatinine; LDH [lactate dehydrogenase]) or nadir values (hemoglobin; platelet count). Differences were compared using the t test, Wilcoxon Rank Sum, or χ2 test, and receiver operating characteristic (ROC) curve analyses were performed. We identified 46 cases of aHUS and 45 cases of HELLP syndrome in the postpartum period. Women with HELLP syndrome were older, but rates of nulliparity and cesarean delivery, and gestational age at delivery, were similar between groups. Peak serum creatinine and LDH values after delivery were the most useful to diagnose aHUS with area under the curve 0.996 (95% CI, 0.99–1.0) and 0.91 (95% CI, 0.83–0.98) respectively. Serum creatinine ≥1.9 mg/dL, LDH ≥1832 U/L, or serum creatinine ≥1.9 mg/dL in combination with LDH ≥600 U/L were the optimal thresholds for diagnosing pregnancy-associated aHUS. We conclude that standard laboratory data, most specifically peak serum creatinine and LDH, may be used to differentiate aHUS and HELLP syndrome in the postpartum period. |
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AbstractList | Pregnancy-associated atypical hemolytic uremic syndrome (aHUS) is a life-threatening thrombotic microangiopathy which may be mistaken for hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. We sought to identify laboratory parameters that differentiate aHUS and HELLP syndrome in the postpartum period. PubMed was searched from inception to March 2018 to identify cases of aHUS in the postpartum period, while cases of HELLP syndrome were identified from a cohort of deliveries at our institution from January 2015 to December 2018. Postpartum laboratory data were abstracted as either peak values (AST [aspartate transaminase]; creatinine; LDH [lactate dehydrogenase]) or nadir values (hemoglobin; platelet count). Differences were compared using the
t
test, Wilcoxon Rank Sum, or χ
2
test, and receiver operating characteristic (ROC) curve analyses were performed. We identified 46 cases of aHUS and 45 cases of HELLP syndrome in the postpartum period. Women with HELLP syndrome were older, but rates of nulliparity and cesarean delivery, and gestational age at delivery, were similar between groups. Peak serum creatinine and LDH values after delivery were the most useful to diagnose aHUS with area under the curve 0.996 (95% CI, 0.99–1.0) and 0.91 (95% CI, 0.83–0.98) respectively. Serum creatinine ≥1.9 mg/dL, LDH ≥1832 U/L, or serum creatinine ≥1.9 mg/dL in combination with LDH ≥600 U/L were the optimal thresholds for diagnosing pregnancy-associated aHUS. We conclude that standard laboratory data, most specifically peak serum creatinine and LDH, may be used to differentiate aHUS and HELLP syndrome in the postpartum period. [Figure: see text]. Pregnancy-associated atypical hemolytic uremic syndrome (aHUS) is a life-threatening thrombotic microangiopathy which may be mistaken for hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. We sought to identify laboratory parameters that differentiate aHUS and HELLP syndrome in the postpartum period. PubMed was searched from inception to March 2018 to identify cases of aHUS in the postpartum period, while cases of HELLP syndrome were identified from a cohort of deliveries at our institution from January 2015 to December 2018. Postpartum laboratory data were abstracted as either peak values (AST [aspartate transaminase]; creatinine; LDH [lactate dehydrogenase]) or nadir values (hemoglobin; platelet count). Differences were compared using the t test, Wilcoxon Rank Sum, or χ2 test, and receiver operating characteristic (ROC) curve analyses were performed. We identified 46 cases of aHUS and 45 cases of HELLP syndrome in the postpartum period. Women with HELLP syndrome were older, but rates of nulliparity and cesarean delivery, and gestational age at delivery, were similar between groups. Peak serum creatinine and LDH values after delivery were the most useful to diagnose aHUS with area under the curve 0.996 (95% CI, 0.99–1.0) and 0.91 (95% CI, 0.83–0.98) respectively. Serum creatinine ≥1.9 mg/dL, LDH ≥1832 U/L, or serum creatinine ≥1.9 mg/dL in combination with LDH ≥600 U/L were the optimal thresholds for diagnosing pregnancy-associated aHUS. We conclude that standard laboratory data, most specifically peak serum creatinine and LDH, may be used to differentiate aHUS and HELLP syndrome in the postpartum period. |
Author | Java, Anuja Moyle, Kimberly Burwick, Richard M. Gupta, Megha |
AuthorAffiliation | Department of Obstetrics and Gynecology, University of Utah Health (K.M.) Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, Yale University, New Haven, CT (M.G.) Division of Nephrology, Department of Medicine, Washington University School of Medicine in St. Louis (A.J.) From the Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA (R.M.B.) |
AuthorAffiliation_xml | – name: Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, Yale University, New Haven, CT (M.G.) – name: From the Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA (R.M.B.) – name: Department of Obstetrics and Gynecology, University of Utah Health (K.M.) – name: Division of Nephrology, Department of Medicine, Washington University School of Medicine in St. Louis (A.J.) |
Author_xml | – sequence: 1 givenname: Richard M. surname: Burwick fullname: Burwick, Richard M. organization: From the Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA (R.M.B.) – sequence: 2 givenname: Kimberly surname: Moyle fullname: Moyle, Kimberly organization: Department of Obstetrics and Gynecology, University of Utah Health (K.M.) – sequence: 3 givenname: Anuja surname: Java fullname: Java, Anuja organization: Division of Nephrology, Department of Medicine, Washington University School of Medicine in St. Louis (A.J.) – sequence: 4 givenname: Megha surname: Gupta fullname: Gupta, Megha organization: Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, Yale University, New Haven, CT (M.G.) |
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Snippet | Pregnancy-associated atypical hemolytic uremic syndrome (aHUS) is a life-threatening thrombotic microangiopathy which may be mistaken for hemolysis, elevated... [Figure: see text]. |
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SubjectTerms | Adult Atypical Hemolytic Uremic Syndrome - blood Atypical Hemolytic Uremic Syndrome - diagnosis Creatinine - blood Diagnosis, Differential Female HELLP Syndrome - blood HELLP Syndrome - diagnosis Humans L-Lactate Dehydrogenase - blood Platelet Count Postpartum Period Pregnancy Young Adult |
Title | Differentiating Hemolysis, Elevated Liver Enzymes, and Low Platelet Count Syndrome and Atypical Hemolytic Uremic Syndrome in the Postpartum Period |
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