Hepatic Infarction in a Patient With Sickle Cell Trait Presenting With HELLP Syndrome.

Area of Science:

• Obstetrics and Gynecology
• Hepatology
• Hematology

Background:

• Hepatic infarction is rare due to dual liver blood supply, often linked to post-transplant complications, surgery, or shock.
• Hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome is an obstetric emergency associated with elevated liver enzymes, particularly in pre-eclampsia.
• Sickle cell disease is known to cause hepatic infarction, but the effect of sickle cell trait is less understood.

Observation:

• A pregnant patient with underlying sickle cell trait presented with clinical features of HELLP syndrome.
• Despite prompt cesarean delivery, liver enzymes rose post-operatively, and CT scan confirmed multifocal hepatic infarctions.
• Pre-eclampsia was a contributing factor due to impaired oxygenation and hepatic hypoperfusion.

Findings:

• This case demonstrates hepatic infarction as a rare complication of HELLP syndrome in a patient with sickle cell trait.
• The study suggests pre-eclampsia contributed to hepatic hypoperfusion, potentially exacerbated by sickle cell trait.
• The role of sickle cell trait in potentiating hepatic infarction requires further investigation.

Implications:

• This case underscores the importance of considering HELLP syndrome in pregnant patients with elevated liver enzymes, especially with pre-eclampsia.
• It raises awareness about the potential, though unconfirmed, link between sickle cell trait and hepatic infarction.
• Further research is needed to clarify the specific risks associated with sickle cell trait regarding hepatic complications.