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Hemolysis, elevated liver enzymes, and low platelets syndrome: when is surgical help needed?
Am J Surg. 2009 Dec; 198(6):916-20.AJ

Abstract

BACKGROUND

Life-threatening hemorrhage is a rare event in hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome. Epidemiologic data are lacking to predict patients at risk for hemorrhage requiring surgical consultation. We sought to identify early clinical predictors of hemorrhagic complications in patients at risk for HELLP syndrome.

METHODS

Patients at risk for HELLP syndrome from 1997 to 2007 were identified retrospectively. Variables evaluated in at-risk women were maternal age, gestational history, hepatic transaminase levels, and platelet count. Multiple logistic regression analysis was used to identify independent predictors of poor maternal outcomes, which were defined as hemorrhage requiring transfusion of blood products, need for surgical intervention, hepatic rupture, and death.

RESULTS

A total of 109 at-risk women were identified. Adverse outcomes included transfusions (18%), hemorrhage interventions (8%), damage control laparotomy (2.8%), and hepatic rupture (2.8%). Maternal and perinatal mortality were .9% and 3.7%, respectively. Median transfusion requirements for women with hepatic rupture were 56 U of packed red blood cells, 26 U of fresh-frozen plasma, 18 U of platelets, and 6 U of cryoprecipitate. Multiple logistic regression analysis showed previous gestations (P = .002), platelet count (P = .01), and aspartate aminotransferase level increase (P = .04) were independent predictors of life-threatening hemorrhage. Previous gestations increased the risk of adverse outcome 3-fold.

CONCLUSIONS

Identifiable risk factors predictive of major hemorrhage are thrombocytopenia (<100,000 cells/microL), increase of aspartate aminotransferase level greater than 70 IU/L, and previous gestations.

Authors+Show Affiliations

Department of Surgery, Denver Health Medical Center and University of Colorado at Denver and Health Sciences Center, 777 Bannock St., MC 0206, Denver, CO 80204, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19969152

Citation

Kulungowski, Ann M., et al. "Hemolysis, Elevated Liver Enzymes, and Low Platelets Syndrome: when Is Surgical Help Needed?" American Journal of Surgery, vol. 198, no. 6, 2009, pp. 916-20.
Kulungowski AM, Kashuk JL, Moore EE, et al. Hemolysis, elevated liver enzymes, and low platelets syndrome: when is surgical help needed? Am J Surg. 2009;198(6):916-20.
Kulungowski, A. M., Kashuk, J. L., Moore, E. E., Hutting, H. G., Sadaria, M. R., Cothren, C. C., Johnson, J. L., & Sauaia, A. (2009). Hemolysis, elevated liver enzymes, and low platelets syndrome: when is surgical help needed? American Journal of Surgery, 198(6), 916-20. https://doi.org/10.1016/j.amjsurg.2009.05.035
Kulungowski AM, et al. Hemolysis, Elevated Liver Enzymes, and Low Platelets Syndrome: when Is Surgical Help Needed. Am J Surg. 2009;198(6):916-20. PubMed PMID: 19969152.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hemolysis, elevated liver enzymes, and low platelets syndrome: when is surgical help needed? AU - Kulungowski,Ann M, AU - Kashuk,Jeffry L, AU - Moore,Ernest E, AU - Hutting,Haley G, AU - Sadaria,Miral R, AU - Cothren,C Clay, AU - Johnson,Jeffrey L, AU - Sauaia,Angela, PY - 2009/02/17/received PY - 2009/05/18/revised PY - 2009/05/18/accepted PY - 2009/12/9/entrez PY - 2009/12/9/pubmed PY - 2010/1/6/medline SP - 916 EP - 20 JF - American journal of surgery JO - Am J Surg VL - 198 IS - 6 N2 - BACKGROUND: Life-threatening hemorrhage is a rare event in hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome. Epidemiologic data are lacking to predict patients at risk for hemorrhage requiring surgical consultation. We sought to identify early clinical predictors of hemorrhagic complications in patients at risk for HELLP syndrome. METHODS: Patients at risk for HELLP syndrome from 1997 to 2007 were identified retrospectively. Variables evaluated in at-risk women were maternal age, gestational history, hepatic transaminase levels, and platelet count. Multiple logistic regression analysis was used to identify independent predictors of poor maternal outcomes, which were defined as hemorrhage requiring transfusion of blood products, need for surgical intervention, hepatic rupture, and death. RESULTS: A total of 109 at-risk women were identified. Adverse outcomes included transfusions (18%), hemorrhage interventions (8%), damage control laparotomy (2.8%), and hepatic rupture (2.8%). Maternal and perinatal mortality were .9% and 3.7%, respectively. Median transfusion requirements for women with hepatic rupture were 56 U of packed red blood cells, 26 U of fresh-frozen plasma, 18 U of platelets, and 6 U of cryoprecipitate. Multiple logistic regression analysis showed previous gestations (P = .002), platelet count (P = .01), and aspartate aminotransferase level increase (P = .04) were independent predictors of life-threatening hemorrhage. Previous gestations increased the risk of adverse outcome 3-fold. CONCLUSIONS: Identifiable risk factors predictive of major hemorrhage are thrombocytopenia (<100,000 cells/microL), increase of aspartate aminotransferase level greater than 70 IU/L, and previous gestations. SN - 1879-1883 UR - https://www.unboundmedicine.com/medline/citation/19969152/Hemolysis_elevated_liver_enzymes_and_low_platelets_syndrome:_when_is_surgical_help_needed L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9610(09)00576-5 DB - PRIME DP - Unbound Medicine ER -