HELLP syndrome: its clinical and laboratory features and imbalance of placental angiogenic factors


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Abstract

Objective. To investigate the clinical and laboratory characteristics of HELLP syndrome and to compare the clinical manifestations of nephropathy in women with moderate and severe preeclampsia (PE) and HELLP syndrome, by correlating them with the blood levels of placental growth factor (PlGF) and soluble fms-like tyrosine kinase 1 (sFlt-1). Material and methods. The course and outcome of pregnancies were studied in 141 women who were divided into 4 groups: 1) HELLP syndrome; 2) severe PE; 3) moderate PE; and 4) a control group. The investigators assessed and compared main laboratory, clinical, biochemical, and immunological parameters, including imbalance of placental angiogenic factors (sFlt-1 and PlGF) and conducted instrumental studies. Results. The patients with HELLP syndrome were found to have a significantly lower sFlt-1/PLGF ratio (median value, 254±93.51 pg/ml) than those with severe (median values, 439.08±112.29pg/ml) or moderate (306.62±164.59 pg/ml) PE. In addition to damage to the liver, the signs of involvement of other organs in the pathological process were seen in almost all the patients; at the same time renal failure was more pronounced than in those with PE (median values of serum creatinine was 110.80±20.62, 73.26±4.55, and 71.73±6.16 ymol/l in HELLP syndrome, severe PE, and moderate PE, respectively). There was a moderate direct correlation of the level of lactate dehydrogenase (LDH) with that of creatinine (r = 0.539) and total bilirubin (r = 0.606) and an inverse correlation of LDH with platelets (r = -0.384). The role of the imbalance of placental angiogenic markers in the development of clinical manifestations in HELLP syndrome was discussed. Conclusion. HELLP syndrome is unlikely to be a more severe variant of PE. HELLP syndrome is a clinically manifest variant of thrombotic microangiopathy. PE appears to be only a trigger for the development of HELLP syndrome.

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About the authors

Tatyana V. Kirsanova

National Medical Research Center of Obstetrics, Gynecology, and Perinatology named after Academician V.I. Kulakov, Ministry of Health of Russia

Email: A_Tatya@mail.ru
Candidate of Medical Science, Senior Researcher Department of Reproductive Hematology and Clinical Hemostasiology

Maria A. Vinogradova

National Medical Research Center of Obstetrics, Gynecology, and Perinatology named after Academician V.I. Kulakov, Ministry of Health of Russia

Email: mary-grape@ya.ru
Candidate of Medical Science, Head. Department of Reproductive Hematology and Clinical Haemostasiology

Alina I. Kolyvanova

M.V. Lomonosov Moscow State University

Email: koluvanova@gmail.com
clinical resident of the Department of Internal Medicine of the Faculty of Fundamental Medicine

Roman Georgievich Shmakov

National Medical Research Center of Obstetrics, Gynecology, and Perinatology named after Academician V.I. Kulakov, Ministry of Health of Russia

Email: r_shmakov@oparina4.ru
MD, Ph.D.

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