ATYPICAL HELLP SYNDROME: CASE REPORT

• Autor(a) principal: Bernardo, Thiago Tavares
• Data de Publicação: 2017
• Outros Autores: Nunes, Kárita Morrana de Lima, Gonçalves, Kelli da Silva, Machado, Ana Carolina Cesário, Martins, Jessika Arguelo, Valinho, Sumara Vargas Hubner, Cordeiro, Kathelyn Ferreira
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Revista Científica da Faculdade de Medicina de Campos
• Texto Completo: https://www.fmc.br/ojs/index.php/RCFMC/article/view/52
• topic: Emergências; Obstetrícia; Síndrome HELLP; Emergencies; HELLP Syndrome; Obstetrics.; Emergencies; HELLP Syndrome; Obstetrics

Introduction: HELLP is a acronym described in 1982 1 for a syndrome that presents with hemolysis (H), elevated liver enzymes (EL) and low platelets (LP) in a patient with pre-eclampsia or eclampsia 2. It can be complete or incomplete, having diagnostic criteria for it 3. The most frequent signs and clinical manifestations are proteinuria, hypertension, epigastric pain, nausea and headache 2. It is more common in the third trimester, but may also occur in the second trimester and postpartum 2. Objectives: To report an unusual case of a patient with early HELLP syndrome. Methods: Descriptive and documentary study based on the collection of clinical and laboratory data, as well as literature review in the electronic databases. Case report: A pregnant woman, 29 years old, black, multiparous, sought obstetric emergency service with complaints of epigastric pain and abdominal discomfort in the upper right quadrant, as well as nausea and vomiting. Reduced levels of platelets and elevated levels of AST and ALT were found. The patient was hospitalized. After presenting with epistaxis, she was referred to a reference maternity hospital for high risk pregnancy, where she had an acute hypertension. The set of signs and symptoms guided the diagnosis of HELLP syndrome, and a caesarean delivery was performed. During the procedure, the patient had a difficult controlling hemorrhage and an unusual therapeutic measure was performed for the reversion of the condition, which was based on the use of tranexamic acid in bolus. The puerpera was kept under observation in the ICU, then released to the ward and, after a few days, she was discharged. Discussion: the condition was very early and atypical, which could have worsened the patient's clinical condition if it had not been diagnosed in time, and the alternative therapeutic approach used to reverse the uncontrolled hemorrhage was extremely important. Conclusion: HELLP syndrome is an important obstetric complication, which should be systematically investigated in the presence of signs and symptoms that may suggest its occurrence, in order to improve the prognosis of the patient and, where possible, the fetus. In addition, the use of tranexamic acid in bolus in these complicated cases is a procedure that can be adopted to reverse the hemorrhagic condition 4, thus pregnant women with epigastric and/or upper quadrant abdominal pain should be investigated systematically 5.   Keywords: Emergencies; HELLP Syndrome; Obstetrics.