The Fibrinogen/CRP Ratio as a New Parameter for the Prediction of Disseminated Intravascular Coagulation in Patients with HELLP Syndrome

Abstract

The HELLP syndrome is a serious complication in pregnancy characterized by haemolysis (H), elevated liver enzymes(EL) and low platelet count (LP)occurring in 0.5 to 0.9% of all pregnancies and in 10–20% of cases with severe preeclampsia. This syndrome usually develops suddenly between 28- 36 weeks gestation. Its etiology and pathogenesis are not well understood. Generally, the disorder is considered a placenta-instigated, liver-targeted acute inflammatory condition, with elements of disordered immunological processes The mortality rate of women with HELLP syndrome is approximately1.1%, from 1 to 25 % of affected female develops serious complications such as disseminated intra vascular coagulopathy (DIC), Placental Abruption, adult respiratory Distress Syndrome, Hepatorenal failure, pulmonary edema, sub capsular hematoma and Hepatic rupture. A significant percentage of patients receive blood products DIC is one of the leading causes for maternal mortality worldwide although DIC results from a wide spread activation of both clotting and fibrinolysis systems leading to 1) systemic production of fibrin split products, and thrombi  Summary 89 that leads to end-organ ischemia; 2) increased vascular permeability due to activation of the kinin system; and 3) microangiopathic hemolysis, during pregnancy hemorrhage is the leading mechanisms for the development DIC.