RT Journal Article
SR Electronic
T1 Disseminated intravascular coagulation complicating HELLP syndrome: perioperative management
JF BMJ Case Reports
FD BMJ Publishing Group Ltd
SP bcr1020081027
DO 10.1136/bcr.10.2008.1027
VO 2009
A1 Rakesh Garg
A1 M P Nath
A1 A P Bhalla
A1 Ashwani Kumar
YR 2009
UL http://casereports.bmj.com/content/2009/bcr.10.2008.1027.abstract
AB HELLP syndrome may lead to disseminated intravascular coagulation (DIC) which can make emergency surgery a serious challenge. A 29-year-old female presented with haematuria, epistaxis and hypertension in the emergency ward and a diagnosis of DIC complicating HELLP in preeclampsia was made. She had continuous epistaxis and elective tracheal intubation was carried out. During emergency caesarean section the patient was managed with blood products, antihypertensive drugs and general anaesthesia together with invasive monitoring. She required postoperative ventilatory support. HELLP syndrome may progress to DIC in 15–38% of patients. The prothrombin time, activated partial thromboplastin time and serum fibrinogen levels are normal in HELLP syndrome but are prolonged in DIC. Evaluation of more sensitive markers of DIC, such as antithrombin III, α-2 antiplasmin, plasminogens, fibrin monomer and D-dimers, differentiates DIC from HELLP syndrome. Aggressive treatment is indicated and delivery should be expedited, by caesarean section if necessary although vaginal delivery is not contraindicated, along with control of blood pressure and coagulation abnormality. We conclude that patients with DIC complicating HELLP syndrome and preeclampsia require great vigilance and multimodal management in the perioperative period for uneventful outcome.