Question 21.1

Created on Wed, 05/13/2015 - 02:44
Last updated on Thu, 04/13/2017 - 23:58
Pass rate: 93%
Highest mark: 10

Other SAQs in this paper

Other SAQs on this topic

A 28-year-old 35-week pregnant woman presents to the Emergency Department with acute onset epigastric pain. The biochemical profile and haematology report are as follows:

Parameter

Result

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

22 – 27

Urea

4.3 mmol/L

3.0–8.0

Creatinine

0.07 mmol/L

0.07 – 0.12

Calcium

2.35 mmol/L

2.15 – 2.6

Corrected Calcium

2.53 mmol/L

2.15 – 2.8

Phosphate

2.75 mmol/L*

0.7 –1.4

Magnesium

0.8 mmol/L

0.7 –1.0

Glucose

4.7 mmol/L

3.6 –7.7

Albumin

36 G/L

33 – 47

CK

71 U/L

<160

Total Bilirubin

40 micromol/L*

4 – 20

GGT

45 U/L

0 – 50

ALP

185 U/L*

40 – 110

LDH

748 U/L*

110 – 250

AST

241 U/L*

<40

ALT

189 U/L*

<40

Haemoglobin

88 G/L*

110 – 160

White Cell Count

12.4 x 109/L

4.0 –15.0

Platelets

64 x 109/L*

150 – 400

  • What is the most likely diagnosis?
  • Give two additional tests that would support your diagnosis

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College Answer

  • HELLP syndrome
  • Haptoglobins – low
  • Blood film showing evidence of haemolysis

Discussion

The diagnosis and management of HELLP syndrome is well covered elsewhere.

The things to look for:

  • Blood film shows fragmented RBCS - schistocytes
  • There is a raised reticulocyte count
  • The unconjugated bilirubin fraction increases
  • The haptoglobin decreases (as haptoglobin/hemoglobin complexes are removed)

Thus, one would order the following tests:

  • Blood film
  • Reticulocyte count
  • Unconjugated fraction of bilirubin
  • Haptoglobin

References

Oh's Intensive Care manual: Chapter 63   (pp. 677) Preeclampsia  and  eclampsia by Wai  Ka  Ming  and  Tony  Gin

Haram, Kjell, Einar Svendsen, and Ulrich Abildgaard. "The HELLP syndrome: clinical issues and management. A review." BMC pregnancy and childbirth 9.1 (2009): 8.