HELLP And DIC Flashcards

1
Q

What is HELLP?

A

(H)Haemolysis
(EL)Elevated Liver Enzymes
(LP)Low Platelets

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2
Q

What is HELLP?

A

A complication of pregnancy which usually presents in women with pre-eclampsia or eclampsia. Women show signs of liver damage and abnormalities in clotting (NICE 2016)

Although it’s debatable whether HELLP is a complication of severe pre-eclampsia or a totally separate disease altogether.

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3
Q

How often does HELLP syndrome occur?

A

In 0.5 - 0.9% of all pregnancies and in 10-20% of cases with severe pre-eclampsia

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4
Q

What are the risk factors for developing HELLP?

A
  • Age >35
  • Primip
  • Previous PIH
  • Multiple pregnancy
  • Previous HELLP Syndrome
  • Caucasian racial origin
  • Antiphosphlipid Syndrome (APS) (an autoimmune condition that makes the blood more likely to clot)
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5
Q

In what ways can HELLP be presented?

A
  • 70% of cases present before delivery (peaking between 27-37 weeks.
  • 30% within 48h of delivery
  • Rapid onset
  • Headaches reported in 30-60% of women
  • Visual disturbances (20% of women)
  • Fatigue
  • Malaise (generally feeling of illness/discomfort)
  • Epigastric pain
  • Tenderness over the liver
  • Oedema, hypertension and proteinuria present
  • Characterised by exacerbation of symptoms at night which ease during the day
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6
Q

If HELLP is suspected, following investigation via bloods-what would you expect to see in the blood results?

A
  • Raised liver enzymes with AST or ALT levels >70 IU/L due to liver injury
  • Platelet count <100 due to activation and increased consumption
  • Raised Bilirubin levels due to haemolysis
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7
Q

What are the maternal complications of HELLP syndrome?

A
  • Development of DIC
  • Placental abruption
  • Acute renal failure
  • Pulmonary oedema
  • Liver Haematoma
  • Liver rupture
  • Wound infection following LSCS
  • Cerebral haemorrhage or stroke
  • Death
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8
Q

What are the fetal complications?

A
  • Perinatal Death
  • IUGR
  • Preterm Delivery
  • Neonatal thrombocytopoenia (low platelets, bleeding)
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9
Q

How is HELLP managed?

A
  • Urgent obsetric and Anaesthetic input required
  • Managed as Severe Pre-eclampsia, considered treatment of Magnesium sulphate (NICE)
  • Control BP with antihypertensives
  • Strict fluid management
  • Corticosteroids considered depending on gestation
  • Consider thromboprophylaxis
  • Consider blood transfusion for RBC/plasma depending on coagulation screening
  • Plan for timing of birth
  • Active management of 3rd stage
  • ICU/HDU
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10
Q

What is the pathology of HELLP syndrome? (In a nut shell)

A
  • Activation of the coagulation system resulting in increased fibrin throughout the body
  • The fibrin deposits on the walls of the blood vessels, triggering the clumping of platelets, causing blood clots and reducing plasma concentration
  • These clumpy deposits narrow the diameter of the blood vessels, raising the blood pressure and reducing the blood flow to the organs
  • Liver is generally affected most causing abnormal liver function and distension which is why women suffer from epigastric pain/discomfort (Myles Textbook)
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11
Q

What does DIC stand for?

A

Disseminated Intravascular Coagulation

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12
Q

What is the pathology of DIC?

A
  • Endothelial damage occurs
  • as a result, activation of blood coagulation occurs to repair tissue damage. Although abnormally large quantities of intravascular fibrin are released.
  • Blood clots form in small and medium sized blood vessels, reducing blood flow to organs
  • Plasma is reduced/exhausted, resulting in haemorrhage
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13
Q

Why does DIC occur?

A

In response to other pathology present at the time- for E.g an infection, such as sepsis

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14
Q

Risk factors for DIC?

A

-Infection (occurs in 30-50% of severe sepsis cases)

  • Malignancy
  • Major Trauma
  • Placental Abruption
  • Amniotic fluid embolism
  • Severe PIH
  • HELLP syndrome
  • Pre-Eclampsia (NICE 2020)

Incidence of 1:1000 pregnancies

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15
Q

Symptoms of DIC?

A
  • Bleeding from three unrelated sites such as site of IV, ears, nose, throat or GI tract.
  • Confusion
  • Fever
  • Haemorrhage
  • Discolouration/cyanosis of extremeties
  • Respiratory distress
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16
Q

What is the management of DIC?

A
  • FBC, Coagulation screen and X match
  • Monitor vital signs
  • Insert urinary catheter and monitor fluid balance
  • plan to expedite birth?
  • Examine Placenta
  • Take cord samples?