title: [HELLP syndrome in triplet pregnancy complicated by DIC and transient diabetes insipidus].
abstract: A 29-year-old woman with a triplet pregnancy received emergency caesarean section in the 33rd week of pregnancy. She lost 2 babies, one of whom was a fetal death and the other a neonatal death. Three weeks before delivery, she was admitted to hospital suffering from vomiting, diarrhea and polyuria. There were no laboratory abnormalities such as a slightly elevated levels of liver enzymes, nor any clinical symptoms of preeclampsia. At the end of the operation, disseminated intravascular coagulation (DIC) occurred and HELLP syndrome was diagnosed. However, the hemoglobin level was in the normal range at this point. On the 2nd postoperative day, hemolytic anemia developed in spite of the resolution of other problems. We suggested that the hemolysis, which may have been caused by a latent hemoconcentration and a membrane disorder of the red cells, was an osmotic hemolysis. This case was unique for the following reasons; 1) a lack of symptoms of hypertension, proteinuria and edema, 2) complications due to diabetes insipidus, 3) postpartum severe hemolysis following latent hemoconcentration, and 4) slow progress of the condition after onset. Early detection of HELLP syndrome is difficult. It should be considered in the management of patients with unrecognizable hemoconcentration and nonspecific complications.
authors.affiliation: Department of Anesthesia, Center for Adult Disease, Kurashiki.
authors.forename: S
authors.initials: S
authors.lastname: Okada
authors.forename: K
authors.initials: K
authors.lastname: Okada
authors.forename: K
authors.initials: K
authors.lastname: Nishitani
mesh_terms: D000328:Adult; D000743:Anemia, Hemolytic / Q000209:etiology; D000768:Anesthesia, General; D000773:Anesthesia, Obstetrical; D002585:Cesarean Section; D003919:Diabetes Insipidus / Q000150:complications*; D004211:Disseminated Intravascular Coagulation / Q000209:etiology*; D004630:Emergencies; D005260:Female; D017359:HELLP Syndrome / Q000209:etiology*; D006801:Humans; D019990:Perioperative Care; D011247:Pregnancy; D011248:Pregnancy Complications; D014310:Triplets