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31 P magnetic resonance spectroscopy of the liver in HELLP syndrome
Author(s) -
Magee Laura A.,
Dixon Ruth M.,
Kemp Graham J.,
Redman Christopher W. G.,
Styles Peter
Publication year - 1999
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/j.1471-0528.1999.tb08328.x
Subject(s) - hellp syndrome , medicine , endocrinology , chemistry , platelet , nucleoside triphosphate , preeclampsia , pregnancy , biology , biochemistry , nucleotide , genetics , gene
Objectives Using magnetic resonance spectroscopy (MRS) to measure phosphorus‐containing metabolites in the liver, this study aimed to investigate non‐invasively whether or not women with haemolysis, elevated liver enzymes and low platelets (HELLP) have detectable abnormalities of hepatic energetics. Setting John Radcliffe Hospital, Oxford. Design Prospective study. Methods After giving informed consent, patients with HELLP syndrome ( n = 7 ) and controls with severe Pre‐eclampsia ( n = 3 ), were studied by 31 P MRS of the liver as soon as possible after delivery (range 2–4 days) and compared with normal nonpregnant controls ( n = 6 ). Haematological and biochemical tests were performed serially and on the day of the MRS in all pregnant patients. Results The severity of HELLP varied as follows: peak aspartate aminotransferase (range 129–2574), peak gamma glutamyl transferase (range 28–96), peak lactate dehydrogenase (range 305–2820), nadir platelets (range 25–1 14), peak international normalised ratio for prothrombin time (before fresh frozen plasma) (range 0.9–1.9). One pregnancy was terminated but all others resulted in live births and all mothers made uneventful, rapid recoveries. MRS‐determined relative hepatic concentrations of phosphorus–containing metabolites and absolute concentrations of adenosine triphosphate did not differ significantly between groups. One patient with the most clinically severe HELLP syndrome (by laboratory criteria) exhibited magnetic resonance spectra which showed a relative increase in phomonoester and an absolute decrease in hepatic adenosine triphosphate (to 62% of control). Conclusions Enthusiasm for the conservative management of HELLP syndrome that develops remote from term has been tempered by the inability to identify patients at risk for progression to hepatic necrosis. We found that most patients with HELLP syndrome had normal liver metabolism as assessed by MRS. However, clinically severe HELLP syndrome can be associated with disturbed hepatic metabolism consistent with that seen in hepatic ischaemia and or granulocytic infiltration of the liver.