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Re: HELLP SYNDROMEFrom: dahmd@gate.netFri Oct 18 19:23:06 1996
In article "R. Daniel Braun" <rBraun@IUNET.IUPUI.EDU> writes:
I wrote:
> I do think, however, that a CBC about every 6-12 hours is reasonable to
Daniel Braun replied:
>How are the thrombocytopenia and/or anemia going to affect the route of I would guess that you would be reluctant to do a c/section on a preeclamptic patient with a platelet count of 18,000. Let me explain my thinking via a very reasonable clinical situation: A patient with severe preeclamsia and right upper quadrant pain is undergoing induction of labor, and has now progressed to 5cm in 6 hours and is in active labor. A "baseline" serum chemistry on arrival shows liver function tests 2-3 times normal, and an elevated bilirubin, and a complete blood count shows hemoglobin of 7.0 and platelets of 84,000. A repeat CBC 6 hours after the "baseline" shows platelets at 32,000. Given the rapidly developing thrombocytopenia I would crossmatch, and do a c/section before things get worse and she ends up with a platelet count of 15,000 and intraoperative bleeding. (I suppose another option would be platelet transfusion at 20-50,000 with continued induction, but I would not go that route). Since HELLP syndrome, or thromboctyopenia, or DIC can all develop rapidly in an otherwise uncomplicated patient, and can lead to difficult to control bleeding, I want to know the patients platelet count as she progresses. Plus, HELLP can develop postpartum, and it may take 48-72 hours for HELLP to resolve. Finally, in some patients the platelet count, for example, can improve and then worsen dramatically even in the postpartum patient. Since a rapidly dropping platelet *will* change my method of delivery as described above, I like to see an acceptable platelet count every 6-8 hours in severe preeclamptic patients until resolution of her condition. I tried to look for a randomized trial where patients got serial labs while others did not, but could not find one. I do remember one paper about 5-6 years ago that showed if patients had a platelet count above 100,000 that coagulation studies were not necessary. Thanks, Ashley D. Ashley Hill, M.D. dahmd@gate.net Orlando, FL
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