title: Hemolysis and elevated transaminases imitating severe preeclampsia.
abstract: 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.
authors.affiliation: From the Departments of Internal Medicine and Obstetrics and Gynecology, University of Iowa College of Medicine Iowa City, Iowa.
authors.forename: Bridget
authors.initials: B
authors.lastname: Kamen
authors.forename: Mark A
authors.initials: MA
authors.lastname: Karwal
authors.forename: Jerome
authors.initials: J
authors.lastname: Yankowitz
mesh_terms: 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
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase