Abstract | BACKGROUND: CASE: A 33-year-old woman, a multigravida, was delivered at 36 weeks' gestation because of pregnancy-induced hypertension and HELLP syndrome. Postpartum, the patient became obtunded, disoriented, and anuric. Her laboratory values revealed a Coombs-negative, microangiopathic hemolytic anemia, modestly abnormal coagulation studies, and thrombocytopenia. She also had elevated liver enzymes, lactate dehydrogenase, and creatinine. The largest plasma von Willebrand factor multimeric forms were relatively decreased in her ethylenediaminetetra- acetic acid-platelet-poor plasma. A diagnosis of thrombotic thrombocytopenic purpura was made. The patient received plasma exchange, hemodialysis, blood transfusion, and glucocorticoids. She responded to therapy, but was later noted to have increasing hepatosplenomegaly, rising levels of bilirubin, and elevated alkaline phosphatase. A Doppler study and magnetic resonance imaging demonstrated the absence of flow in the middle and left hepatic veins, secondary to thrombosis ( Budd-Chiari syndrome). She was maintained on warfarin therapy and was discharged on postpartum day 50. CONCLUSION:
|
Authors | H W Hsu, M A Belfort, S Vernino, J L Moake, K J Moise Jr |
Journal | Obstetrics and gynecology
(Obstet Gynecol)
Vol. 85
Issue 5 Pt 2
Pg. 839-43
(May 1995)
ISSN: 0029-7844 [Print] United States |
PMID | 7724132
(Publication Type: Case Reports, Journal Article)
|
Topics |
- Adult
- Budd-Chiari Syndrome
(complications, diagnosis, therapy)
- Diagnosis, Differential
- Female
- HELLP Syndrome
(diagnosis)
- Humans
- Magnetic Resonance Imaging
- Plasma Exchange
- Platelet Transfusion
- Postpartum Period
- Pre-Eclampsia
(diagnosis)
- Pregnancy
- Purpura, Thrombotic Thrombocytopenic
(complications, diagnosis, therapy)
- Tomography, X-Ray Computed
|