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Differentiation of acute fatty liver of pregnancy from syndrome of hemolysis, elevated liver enzymes and low platelet counts
Author(s) -
Minakami Hisanori,
Morikawa Mamoru,
Yamada Takahiro,
Yamada Takashi,
Akaishi Rina,
Nishida Ryutaro
Publication year - 2014
Publication title -
journal of obstetrics and gynaecology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.597
H-Index - 50
eISSN - 1447-0756
pISSN - 1341-8076
DOI - 10.1111/jog.12282
Subject(s) - hellp syndrome , medicine , acute fatty liver of pregnancy , amplified fragment length polymorphism , hemolysis , pregnancy , differential diagnosis , gastroenterology , pediatrics , preeclampsia , pathology , genetics , fetus , biology , population , environmental health , genetic diversity
Abstract As proposed criteria ( S wansea criteria) for the diagnosis of acute fatty liver of pregnancy ( AFLP ) do not include antithrombin ( AT ) activity, diagnosis of AFLP may be delayed. The aim of this review is to underscore problems in the differential diagnosis of AFLP and the syndrome of hemolysis, elevated liver enzymes and low platelet counts ( HELLP syndrome) and to facilitate prompt diagnosis of AFLP . Published works dealing with liver dysfunction in pregnancy, HELLP syndrome and AFLP were reviewed. AFLP and HELLP syndrome shared common clinical, laboratory, histological and genetic features, and differential diagnosis between them was often difficult. However, HELLP syndrome was likely to occur in patients with hypertension, but AFLP occurred often in the absence of hypertension. In addition, AFLP was exclusively associated with pregnancy‐induced antithrombin deficiency ( PIATD ). Approximately 50% of patients with AFLP did not have thrombocytopenia at presentation. As the S wansea criteria for AFLP did not include PIATD , diagnosis of AFLP was delayed until manifestation of life‐threatening complications; 60% of women were admitted to intensive care and 15% to a specialist liver unit. In conclusion, incorporation of AT activity of less than 65% into the diagnostic criteria for AFLP may facilitate suspicion and prompt diagnosis of AFLP , decrease uncertainty regarding the diagnosis of AFLP , and contribute to better investigation and understanding of the process leading to the development of liver dysfunction.