Can Schistocytes Percentage in the Peripheral Blood Smear Predict Cases of Thrombotic Thrombocytopenic Purpura in Women Provisionally Diagnosed as HELLP Syndrome?

Abstract

The syndrome of Hemolysis, Elevated Liver Enzymes, Low Platelets (HELLP syndrome) is a serious and unclear disease. But, most patients will show evidence of improvement from the disease progress within 48 hours after delivery. However, Thrombotic Thrombocytopenic Purpura (TTP) which mimic the same clinical and biochemical findings of HELLP syndrome will lead to a worsening clinical picture. Schistocytes present in the peripheral blood film in almost all women with Thrombotic Microangiopathy Syndrome (TMA) including both HELLP syndrome and TTP. However, the schistocytes percentage is significantly higher in case of TTP. Nevertheless, until now there is no agreed protocol on how to early differentiate between both conditions in order to initiate the proper treatment which will reduce the maternal morbidity and mortality. Synopsis: Schistocytes percentage in cases provisionally diagnosed as HELLP Syndrome might predict and red fl ag cases with TTP for early multidisciplinary team management. Material and methods: The study was carried out at Ain Shams University Maternity Hospital. All patient with a provisional diagnosis of HELLP syndrome admitted in 2015 were recruited and tested for the schistocytes percentage just before delivery and then subsequently divided into two groups according to whether the condition improved or not after 48 hours of delivery. Results: Schistocytes percentages predelivery were significantly higher in women with suspected TTP, and were exceptionally high in women who died. Conclusion: Schistocytes percentage in peripheral blood smear in cases provisional diagnosed as HELLP Syndrome might predict cases of sustained symptoms in order to red fl ag cases of possible thrombotic microangiopathy as TTP/HUS who will benefit from early diagnosis and multidisciplinary team management.