DDSEP® 8 Quick Quiz

November 2019

Q2. A 29-year-old woman at 37 weeks gestation presents to the emergency room with right upper quadrant pain, nausea, vomiting. She is diagnosed with preeclampsia. She is treated with intravenous magnesium, antihypertensive therapy, and labor is induced. Prior to delivery, laboratory values were as follows: aspartate aminotransferase, 240 U/L; alanine aminotransferase, 220 U/L; total bilirubin, 1.8 mg/dL; hemoglobin, 10.1 g/dL; platelets, 110,000 microL. Forty-eight hours following delivery, she complained of worsening right upper quadrant pain and headache. Repeat laboratory values 48 hours postpartum were as follows: AST, 410 U/L; ALT, 390 U/L; total bilirubin, 5.1 mg/dL; hemoglobin, 7.9 g/dL; and platelets 75,000 microL.

Which of the following is the most likely diagnosis?

Sepsis with hemolytic-uremic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP)

Acute fatty liver of pregnancy

Flare of autoimmune hepatitis

Hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome

Acute hepatitis A infection

Q2. Correct answer: D

Rationale
HELLP syndrome is a multisystemic disorder that is characterized by the development of hemolytic anemia, elevated liver enzymes, and low platelets. Most cases occur between 28 and 36 weeks of gestation, but it can also develop up to 1 week postpartum in 30% of cases.

Reference
Fitzpatrick KE, et al. Risk factors, management, and outcomes of hemolysis, elevated liver enzymes, and low platelets syndrome and elevated liver enzymes, low platelets syndrome. Obstet Gynecol. 2014 Mar;123(3):618-27.

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