Microangiopatía trombótica en gestante que debuta como síndrome de HELLP: un reporte de caso

Abstract

Thrombotic microangiopathy syndrome is composed of a group of disorders characterized by: microangiopathic haemolytic anaemia, thrombocytopenia, and target organ damage. The differential diagnoses are preeclampsia and HELLP syndrome (haemolysis, elevated liver enzymes, and thrombocytopenia), atypical haemolytic uraemic syndrome, acute fatty liver of pregnancy and thrombotic thrombocytopenic purpura (TTP). HELLP syndrome has been historically classified as a complication of severe preeclampsia, however, lately it has been proposed as a completely independent pathology. HELLP syndrome is associated with multiple complications during pregnancy, such as placentation disorders with placental insufficiency, maternal liver disease, neurological involvement, abortion, altered kidney function, premature birth. In this article we present the case of a 22-year-old primiparous patient, with a pregnancy of 31 weeks and 6 days, requiring emergency caesarean section due to severe thrombocytopenia and acute elevation of transaminases and lactic dehydrogenase (LDH). The patient was diagnosed with a thrombotic microangiopathy syndrome, finally concluded as a severe HELLP syndrome, responding satisfactorily to management with plasmapheresis.