BOF: 47
A 38-year-old primigravida presents to the obstetric unit
with a history of vomiting and abdominal pain. She is in her 36th
week of gestation and she is carrying twins.
She also complains of intense thirst and frequent passage
of large volumes of urine. On examination there is epigastric tenderness but no
other physical signs.
Investigations reveal:
Hb 11.5 g/dL
WBC 14 x 109/L
Neutrophils10 x 109/L
Platelets 160 x 109/L
AST 80 U/L
Bilirubin 60 mmol/L
Urea 8.8 mol/L
Creatinine150 mmol/L
Random Blood Glucose 5mmol/L
Abdominal ultrasound scan shows ascites
Which of the following features would help to differentiate
the condition this patient has from the HELLP syndrome?
a)
Elevated bilirubin
b)
Elevated transaminases
c)
Elevated creatinine
d)
Leucocytosis
e)
Vomiting
Answer:
d)
The patient has Acute Fatty Liver of Pregnancy (AFLP). This
is a condition in which the hepatocytes get swollen with microvesicular fat
deposition.
The risk factors are:
§
Older maternal age
§
Primiparity
§
Multiple pregnancy
§
Male foetus
§
Pre ecclampsia
§
Previous AFLP
The features of the disease are six or more of the
following:
§
Vomiting
§
Abdominal pain
§
Polyuria/polydypsia
§
Encephalopathy
§
Leucocytosis
§
Coagulopathy
§
Ascites (USS)
§
Elevated bilirubin
§
Hypoglycaemia
§
Elevated transaminases
§
Elevated ammonia
§
Renal impairment
§
Elevated urate
§
Microvesicular fat on liver biopsy
The differentiating features are as follows:
|
AFLP |
HELLP
|
|
Polyuria/ polydypsia |
Platelets very low |
|
Leucocytosis |
Normal prothrombin time |
|
Elevated prothrombin time |
Anaemia |
|
Hypoglycaemia |
Abnormal blood film |
|
Increased ammonia |
|
Last Updated:1/05/06
