Okada S, Okada K, Nishitani K
Department of Anesthesia, Center for Adult Disease, Kurashiki.
Masui. 1998 Feb;47(2):195-9.
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.
一名怀有三胞胎的29岁女性在妊娠33周时接受了紧急剖宫产。她失去了两个婴儿，其中一个是死胎，另一个是新生儿死亡。分娩前三周，她因呕吐、腹泻和多尿入院。没有实验室异常，如肝酶水平略有升高，也没有先兆子痫的任何临床症状。手术结束时，发生了弥散性血管内凝血（DIC），并诊断为HELLP综合征。然而，此时血红蛋白水平在正常范围内。术后第2天，尽管其他问题得到解决，但仍发生了溶血性贫血。我们认为，溶血可能是由潜在的血液浓缩和红细胞膜紊乱引起的，是一种渗透性溶血。该病例独特之处在于：1）缺乏高血压、蛋白尿和水肿症状；2）因尿崩症出现并发症；3）潜在血液浓缩后产后严重溶血；4）发病后病情进展缓慢。早期发现HELLP综合征很困难。对于有无法识别的血液浓缩和非特异性并发症的患者，在管理中应予以考虑。
