Epigastric pain, low platelets, high liver enzymes, hemolysis (284/1700)

A 32yo woman of 39wks gestation attends the antenatal day unit feeling very unwell with
sudden onset of epigastric pain a/w nausea and vomiting. Temp 36.7C. Exam: RUQ tenderness.
Bloods: mild anemia, low plts, elevated LFT and hemolysis. What is the most likely dx?

a. Acute fatty liver of pregnancy
b. Acute pyelonephritis
c. Cholecystitis
d. HELLP syndrome
e. Acute hepatitis




























answer: D

HELLP syndrome (haemolysis, elevated liver enzymes, and low platelet count).
Incidence in pregnancy: 0.1–0.6%; in pre-eclampsia: 4–12%. It causes upper
abdo pain, malaise, vomiting, headache, jaundice, microangiopathic haemolytic
anaemia, DIC, LDH high, ALT high <500U/L, bilirubin <86μmol/L. It recurs in 20%.
Treatment: get expert help. Admit; deliver if severe.

acute fatty liver of pregnancy has pancreatitis, uremia and hypoglycemia