Complicated Post-Partum HELLP Syndrome Causing Acute Renal Failure and a Spontaneous Acute Subdural Hematoma

Farhan A Shah,Brijesh B Patel,Gilad Guez,Neil Patel

doi:10.7759/cureus.13233

Abstract

HELLP syndrome is characterized by hemolysis, elevated liver enzymes, and thrombocytopenia. It is a devastating illness that typically occurs in the third trimester of gestation. We present a unique case of complicated post-partum HELLP syndrome.The patient was a 34-year-old Caucasian G1PO woman at 40 weeks’ gestational age who presented for induction of labor. She underwent successful vaginal delivery. However, postoperatively the patient developed HELLP syndrome complicated by acute renal failure. She was transferred to the intensive care unit, where her renal function continued to decline, ultimately necessitating hemodialysis. She subsequently spontaneously developed an acute subdural hematoma.Most cases of HELLP syndrome occur in the third trimester, whereas fewer manifest post-partum. The pathophysiology of HELLP syndrome is poorly understood. While the defining organ of injury in HELLP syndrome is the liver, both kidney injury and spontaneous subdural hematomas can occur, as seen in this patient. The gold standard therapy for HELLP syndrome is prompt delivery of the fetus.HELLP syndrome continues to be a serious constellation of symptoms that can affect women late in their gestational period. As illustrated in this case report, prompt diagnosis of HELLP syndrome and appropriate management is critical.

Highlights

Categories: Internal Medicine, Obstetrics/Gynecology Keywords: hellp, acute subdural hematoma, acute renal failure and hemodialysis in icu HELLP syndrome consists of hemolysis, elevated liver enzymes, and thrombocytopenia [1]
We present a unique case of a complicated postpartum HELLP syndrome in a previously healthy 34-year-old Caucasian G1PO woman, resulting in acute renal failure necessitating hemodialysis and a spontaneous acute subdural hematoma
It has been documented that HELLP syndrome occurs in approximately 0.5% to 0.9% of all pregnancies and can occur in a range of 10% to 20% of severe preeclampsia cases [1]

Summary

Introduction

HELLP syndrome consists of hemolysis, elevated liver enzymes, and thrombocytopenia [1]. The patient complained of a pressure-like pain in her lower back She developed decreasing urine output despite adequate intravenous fluid administration, producing less than 50 milliliters of urine over the past 24 hours, as measured through her indwelling Foley urinary catheter. She was found to have several new abnormal laboratory test findings (Table 1), including leukocytosis of 21.57 k/uL, anemia with a hemoglobin of 8.1 g/dL, thrombocytopenia with platelets of 26 k/uL, a new acute kidney injury with BUN/Cr (blood urea nitrogen/creatinine) of 25/3.10 mg/dL, and significantly elevated liver function tests of AST/ALT (aspartate transaminase/ alanine transaminase) equal to 1,275/259 U/L. The patient was thereafter transferred to a different facility to undergo plasmapheresis

Discussion

Conclusions

Disclosures

Findings

Padden MO

18. Sibai BM