Association between the Quantitative Assessment of Schistocytes in Peripheral Blood Smear and Prognosis of Patient Initially Diagnosed as HELLP Syndrome

Abstract

HELLP syndrome is a life-threatening obstetric complication usually considered to be a variant or complication of pre-eclampsia (Haram ., et al 2009). HELLP syndrome may occasionally be confused with other diseases complicating pregnancy: acute fatty liver of pregnancy, gastroenteritis, hepatitis, appendicitis, gallbladder disease, immune thrombocytopenia, lupus flare, antiphospholipid syndrome, hemolytic-uremic syndrome, thrombotic thrombocytopenic purpura, and nonalcoholic fatty liver disease (Page – Girling ., 2011)( Minakami et al., 2014). The distinction between thrombotic thrombocytopenic purpura-hemolytic uremic syndrome and severe preeclampsia is important for therapeutic and prognostic reasons. However, the clinical and histological features are so similar that establishing the correct diagnosis is often difficult; furthermore, these disorders may occur concurrently ( Burns., etal 2004). When TTP/HUS does occur during pregnancy, they often are confused initially with obstetric diagnoses such as severe preeclampsia; hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome; acute fatty liver of pregnancy; eclampsia, and antiphospholipid antibody syndrome. This might be related to the fact that the disease entity is rare and often is unexpected. Nevertheless, a delay in diagnosis of TTP/HUS may result in life-threatening maternal and fetal consequences (Stella ., et al 2009). Aim of study was to Compare the quantitative assessment of schistocytes in peripheral blood smear between women initially diagnosed as HELLP syndrome who show no spontaneous resolution within 48 hrs after delivery and those who show spontaneous resolution within 48 hrs after delivery which may help in decreasing the maternal mortality rate at Ain Shams maternity hospital . The current study included 100 patients who were initially diagnosed as HELLP. Blood sample taken 12hr