Hemolysis and elevated transaminases imitating severe preeclampsia.
BACKGROUND
Illnesses coincident with pregnancy may present similarly to preeclampsia or may be mistaken for severe preeclampsia or hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome. Distinguishing these imitators from preeclampsia is important to allow for appropriate treatment and to avoid unnecessary delivery.


METHODS
A primigravida at 32 2/7 weeks of gestation transferred to our institution with flu-like symptoms, anemia, jaundice, and elevated liver function tests. The team caring for her was concerned about HELLP or acute fatty liver. After extensive workup, she was found to have a cold agglutinin. Her laboratory test results improved, and she was discharged undelivered with a presumptive diagnosis of cold agglutinin autoimmune hemolytic anemia.


CONCLUSIONS
When patients present with atypical features of HELLP syndrome, clinicians should take time to consider other "imitators of preeclampsia" before rapidly progressing to delivery to avoid inappropriate treatment of the disorder.
Kamen
Bridget
B
From the Departments of Internal Medicine and Obstetrics and Gynecology, University of Iowa College of Medicine Iowa City, Iowa.
Karwal
Mark A
MA
Yankowitz
Jerome
J
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000744:Anemia, Hemolytic, Autoimmune / Q000175:diagnosis* / Q000201:enzymology; D001219:Aspartate Aminotransferases / Q000097:blood; D003937:Diagnosis, Differential; D005260:Female; D017359:HELLP Syndrome / Q000175:diagnosis*; D006801:Humans; D008111:Liver Function Tests; D011247:Pregnancy
D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase