A 34 year old lady who is 34 weeks pregnant presents with acute onset epigastric pain. The plasma biochemistry and the haematology report are provided.
|
Test |
Normal Range |
|
Sodium 138 mmol/L |
135-145 |
|
Potassium 4.4 mmol/L |
3.2-4.5 |
|
Chloride 102 mmol/L |
100-110 |
|
Bicarbonate 27 mmol/L |
17-28 |
|
Anion Gap 9 mmol/L |
5-15 |
|
Creatinine 66 micromol/L |
50-100 |
|
Urea 4.3 mmol/L |
1.0-5.0 |
|
Tot Protein 76 H g/L |
55-75 |
|
Albumin 36 g/L |
28-38 |
|
Calcium 2.35 mmol/L |
2.00-2.50 |
|
Ca Alb Cor 2.53 H mmol/L |
2.00-2.50 |
|
Phosphate 1.03 mmol/L |
0.7-1.4 |
|
Magnesium 0.8 mmol/L |
0.7-1.0 |
|
Glucose 4.7 mmol/L |
3.6-7.7 |
|
CK Total 71 U/L |
<160 |
|
LD 748 H U/L |
100-200 |
|
AST 241 H U/L |
10-45 |
|
ALT 189 H U/L |
5-45 |
|
GGT 45 U/L |
10-70 |
|
ALP 185 H U/L |
65-180 |
|
Bilirubin Total 40 micromol/L |
<20 |
|
WCC 12.4 ^9/L |
4.0-15.0 |
1. What is the most likely diagnosis?
2. What 2 additional tests will support your diagnosis?
3. List 4 treatment options
1. What is the most likely diagnosis? HELLP
2. What 2 additional tests will support your diagnosis?
Haptoglobins : low
Blood film showing evidence of hemolysis
3. List 4 treatment options
1) This is HELLP syndrome. The platelets are low, the LDH is high, and there is raised bilirubin.
2) a blood film, reticulocyte count and serum haptoglobin would support this diagnosis
3) There is no specific management strategy for HELLP; delivery of the baby is the only "curative" procedure. Contrary to the college answer, neither plasma exchange nor corticosteroids have been show to improve maternal morbidity or mortality.
HELLP is discussed at lengths elsewhere.