Is there a diurnal pattern in the clinical symptoms of HELLP syndrome?
OBJECTIVE
To determine if there is a diurnal pattern in the clinical symptoms of HELLP (Hemolysis, Elevated Liver enzymes, Low Platelets) syndrome.


METHODS
A retrospective study was performed in 134 pregnancies complicated by HELLP syndrome. The medical records were reviewed to describe each HELLP episode. Time of day was divided into three periods, day, evening, and night. The following parameters were categorized according to the time of day: onset of symptoms, consultation by the doctor, initial blood sampling, diagnosis and decrease of symptoms. Biochemical parameters at clinical presentation and consecutive changes within 24 h were recorded.


RESULTS
In 65 pregnancies 77 HELLP episodes were well documented. Times of onset of symptoms and consultation by the doctor were significantly higher during the evening and night (p < 0.001), whereas times of diagnosis and decrease of symptoms occurred significantly more during the day (p < 0.001). In only 49.3% of the cases were diagnostic laboratory criteria met at clinical presentation. This was mainly due to platelet values in excess of 100 x 10(9)/l. Several hours later (median 8 h, range 2-23) the decrease in platelets occurred.


CONCLUSIONS
A diurnal pattern exists in the clinical symptoms of HELLP syndrome that is characterized by an exacerbation during the night and recovery during the day. There is a considerable delay between the onset of symptoms and the fulfillment of diagnostic laboratory criteria.
Department of Perinatology and Gynaecology, University Medical Centre Utrecht, The Netherlands. svk4@yahoo.com
Steven V
SV
Koenen
Anjoke J M
AJ
Huisjes
Jules
J
Dings
Yolanda
Y
van der Graaf
Gerard H A
GH
Visser
Hein W
HW
Bruinse
D000293:Adolescent; D000328:Adult; D002940:Circadian Rhythm; D005260:Female; D017359:HELLP Syndrome / Q000097:blood* / Q000453:epidemiology / Q000503:physiopathology*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008499:Medical Records; D010976:Platelet Count; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D012017:Referral and Consultation; D012189:Retrospective Studies; D050497:Stillbirth; D013997:Time Factors