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HELLP and DIC

Posted Apr 30 2009 10:13pm
HELLP

H - hemolysis
EL - elevated liver enzymes
LP - low platelets


Put them all together, and you get a wicked bad scenario.

I volunteered to take the patient assignment, of a woman who was slowly developing HELLP syndrome. The initial symptoms came on rather suddenly, and innocuously - elevated blood pressure and some headaches. Not too unusual when you are reaching your 3rd trimester. Normally, you get a blood pressure drop around 28 weeks. Those with gestational hypertension or preeclampsia will not get this blood pressure drop. Well, in this woman, her blood pressure started to creep up. She was started on a medication to lower her BP. All labs were normal.

Then the epigastric pain hits. Suddenly, without warning. Liver enzymes getting wacky. Blood pressure shooting up, then settling down again (this is called labile blood pressure). Magnesium started. Headache sets in. Side effect from magnesium, or worsening hypertension/preeclampsia? Labs climbing, then stabilizing.

Add in some more IV drips that need fine tuned every hour. Yes, she was probably going to get sicker as the day went on, but it was soon my time to turn her over to the next shift.

I have a bad feeling that the proverbial shit will hit the fan very quickly for her. Emergency c/s and NICU admission for the baby.

Problem is, even after delivery, she is still going to be critical. She can still develop what is called DIC (disseminated intravascular coagulation). That's basically where the body goes haywire, and consumes all of it's clotting abilities, while creating microscopic clots all throughout the body. No clotting = bleeding from every cut/opening/sore/IV site/you name it. Tiny blood clots all over the body = organ failure and death. It is highly fatal if not caught and treated in a timely manner.
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