HELLP Syndrome (updated 2023) - CRASH! Medical Review Series 

Thank you for breaking this down. It has helped me understand how the doctors came to their decisions while I had HELLP. I don't remember that time very well, so this is healing to understand.

Great effort Dr Bolin, very much appreciated!

Thank you for clearing up a lecture that did not want to stick to me. I enjoyed your video

Loved your explanation!! 🫶🏻

(On Monday of April 3, 2023). On the Matter of HELLP Syndrome (Updated 2023) by MD Paul W. Bolin (CRASH! Medical Review Series) on the Overa Topic of Obstetrics-Gynecology: 1) Pre-eclampsia-Eclampsia Pathogenesis and/or Hypertensive Disorder of Gestation of Hemolysis, Elevated Liver Enzyme and Low Platelets (Thrombocytopenia), a Laboratory Diagnosis as Microangiopathic Hemolytic Anemia (MAHA) a Matter of Hemolysis, AST, ALT and Thrombocytopenia are Distinctively made via Laboratory Blood Assessment (15-20% Specificity); 2) Risk Factors: 1) Maternal Age (25 is the Average Epidemiological Age for HELLP Syndrome Subjects while Pre-eclampsia is 19); 2) White Race; 3) European Ancestry; 4) Previous Pregnancy marked by HELLP Syndrome (2-27% Specificity); 3) Signs And Symptoms (SSx): 1) Second-Half of Gestation (Or Postpartum Condition) Medical Profile and/or Symptomatology of Acute Onset Epigastric Pain (Right Upper Quadrant [RUQ]); 2) Severe Pre-Eclampsia Symptoms: 1) Nausea, Emesis, and/or Epigastric/RUQ Pain (Specificity of 40-90%); 2) Headache (33-61%); 3) Hypertension (33-88%); 4) Visual Changes (< 20%); 5) Brisk Tendon Reflexes (Hyperreflexia); 6) Jaundice (5%); 3) RUQ Pain or Suspected Pre-Eclampsia should lead to Laboratory Investigations via Complete Blood Count (CBC) and Liver Function Tests (LFTs); 4) Diagnosis (Dx): 1) CBC with PBS (Schistocytes). Such Diagnostic would have Normocytic (MCV 80-100 fL) Anemia, Thrombocytopenia and PBS Schistocytes (Evidence of Hemolysis of Fragmented RBCs) and Helmet Cells; 2) BMP; 3) LFTs; 4) PT/PTT; 5) Serum Amylase and Lipase; 2) BMP would have Elevated Blood Urea Nitrogen (BUN) and Creatinine Ratio (Indicating Abnormal RBCs Process of MAHA); 3) Elevated Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT) at 2x UNL, Lactate Dehydrogenase (LDH) Elevated due both to Hemolysis and Liver Inflammation. Elevated Indirect Bilirubin and Total Bilirubin (Net Hyperbilirubinemia) due to Hemolysis; 4) Prothrombin Time and Partial Thromboplastin Time (PT/PTT) Coagulation Studies can be Normal but Prolonged in Advanced cases; 5) Serum Amylase and Lipase are Normal; 5) Differential Diagnosis (DDx): 1) Acute Fatty Liver of Pregnancy (AFLP) or Hepatic Lipidosis of Pregnancy (Autosomal Recessive Fatty Acid Oxidation Deficiency Disease) has Jaundice, Low to Elevated Liver Enzymes, Leukocytosis, Hypoglycemia, and DIC Complication. Dx is basically Clinical and Admission is warranted on the Basis of Prognosis (18% Mortality Rate) and Tx is Delivery and Supportive Measures; and 2) Thrombotic Thrombocytopenia Purpura (TTP) with Plasma Exchange, Fresh-Frozen Plasma (Glucocorticoids and Relapse Rituximab) and (D-Dimer Normal or Elevated, Fibrinogen Low, Haptoglobin); 6) HELLP Syndrome Treatment (Tx): 1) Delivery (Induced Vaginal Natural Delivery or C-Section Surgery Procedure); 2) And Supportive Therapeutics; 7) Management (Mx): 1) Patient Stabilization: a) Fetal Assessment; b) IV Access For Infusion Based Therapeutics (Magnesium Sulfate); c) Foley Catheter For Bladder Emptying; 2) Fetal Ultrasound and Biophysical Profile; 3) Medication in HELLP Syndrome: a) Labetalol (Non-Selective Adrenergic Receptor Antagonist) for Hypertension (130/90 mm Hg); b) Magnesium Sulfate (Pregnancy Approved Anticonvulsant and an Electrolyte) as Prophylaxis of Seizures; c) Liver Inflammation and Thrombocytopenia with Dexamethasone (Along with a Positive Fetal Surfactant Releasing Effect [Lung Maturing Agent]) of Glucocorticoid Drug Class; 4) Periodic CBC, LFTs for Monitoring Ongoing Process; Abdominal CT if LFTs Warrant a Subcapsular Hematoma; 5) Anesthesiology Notification (Seizure Risk and Anesthesia May be Desired for Peripartum Delivery Pain); 6) Induce Labor: 1) If Unstable, Delivery STAT; b) Less than 34 Weeks and Stable DXM (10 mg 2-4) and Evaluate for Delivery after 24-48 Hours; c) Gestation Duration Greater than or Equal to 34 Weeks DXM and Deliver after 24-48 Hours; 8) Complications (Cx): 1) Disseminated Intravascular Coagulation (DIC) 21% Specificity, Progressive Thrombocytopenia, and Coagulation Abnormality (PT/PTT Prolongation); 2) Abruptio Placentae (AP) 16% of HELLP Syndromes, Vaginal Hemorrhage, Abdominal Pain and Fetal Status Insecurity; 3) Pulmonary Edema/Acute Respiratory Distress Syndrome (ARDS) at 6% with Dyspnea, Angina, and Hypoxia/Hypoxemia; 4) Acute Kidney Injury (AKI) 2-8% Specificity with Oliguria and Creatinine Elevations; 5) Subcapsular Hematoma is seen in 1% of HELLP Syndrome Epidemiologically with LFTs showing Progressive Pattern; 6) Hepatic Rupture is a Rare Complication with Acute (Sudden) Progressive RUQ Pain; 9) Prognosis (Prx): 1) Maternal Mortality Rate is 1.1% with Significant Neonate/Fetus/Infant Mortality and Morbidity 10-60%. Because Massive Hemolytic Anemia is Patent and DIC Progression is Possible, Type And Crossing for RBC Product may be a good Precaution along with Platelet and Cryoprecipitate; 10) Pathology of HELLP is a Complication of the Endothelial Angiogenic Dysfunction of Pre-Eclampsia/Eclampsia with Ischemia-Reperfusion Injury triggering a Systemic Inflammatory Response and Disorder therein mediated by Complement Cascade where Thrombocytes are increasingly consumed, Multiorgan Capillary Ischemia and Hepatic Necrosis ensue building a HELLP Syndrome Clinical Picture. When the Fetus is Delivered these Aforementioned Processes Cease as a Fetus-Maternal Alloimmunogeneicity is plausible in both Pathogenesis And Aetiology (TTP of Fetal Long-Chain 3-Hydroxy Acyl CoA Dehydrogenase Deficiency (LCHAD); Goodness, the Disenchanting Obstetrics of an Unyielding Whirlpool of Genetics and Mosaicism Therein Proliferates so does Diathesis and Alloimmunogeneicity. Just kidding. The HELLP Syndrome was just further Spiced up with DIC and 123. My Revolutionary Totally Biosynthetically Sound Products just made a usually fatal Pregnancy a Breeze of Tahitian Beauty. MD Paul W. Bolin, es geht sehr gut aber man muss lernen wie zu leben und lieben gleichzeitig. Heil!

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