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D-dimer test for early detection of HELLP syndrome
R Neiger1, M O Trofatter, K F Trofatter
1Department of Obstetrics and Gynecology, University of Tennessee Graduate School of Medicine, Knoxville 37920, USA.
Insights
The D-dimer test can identify preeclamptic patients at high risk for HELLP syndrome. D-dimer-negative results indicate a lower risk, suggesting better maternal-fetal outcomes.
Area of Science:
- Obstetrics and Gynecology
- Hematology
- Clinical Chemistry
Background:
- Preeclampsia is a serious pregnancy complication.
- HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count) is a severe variant of preeclampsia.
- Early identification of patients at risk for HELLP syndrome is crucial for timely intervention and improved outcomes.
Purpose of the Study:
- To evaluate the utility of the D-dimer test in predicting the risk of HELLP syndrome in preeclamptic women.
- To assess the correlation between D-dimer test results and clinical and laboratory parameters in preeclampsia.
Main Methods:
- A prospective study involving 81 preeclamptic women and 12 control subjects.
- D-dimer testing was performed on all participants.
- Clinical parameters (mean arterial pressure) and laboratory values (platelet count, liver enzymes) were recorded.
- Maternal and fetal outcomes, including infant birth weight and Apgar scores, were analyzed.
Main Results:
- D-dimer test results were positive in 43 preeclamptic women and negative in 38; all controls were negative.
- D-dimer-positive preeclamptic women exhibited significantly higher mean arterial pressures, lower platelet counts, and elevated liver enzymes compared to D-dimer-negative patients.
- Infants born to D-dimer-positive mothers had significantly lower birth weight and Apgar scores.
- A negative D-dimer test showed a high negative predictive value (0.89) for laboratory abnormalities associated with HELLP syndrome.
Conclusions:
- The D-dimer test is a valuable tool for identifying preeclamptic women at high risk for developing HELLP syndrome.
- D-dimer-positive patients require close monitoring due to increased risk of severe complications.
- D-dimer-negative results suggest a lower likelihood of HELLP syndrome and a better maternal-fetal prognosis.
Abstract:
We attempted to predict patients at risk for HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count) by using the D-dimer test to screen 81 preeclamptic gravidas and 12 control subjects. Among preeclamptic patients, 43 had positive and 38 had negative results of D-dimer tests. All controls had negative results. Women with positive results had significantly higher mean arterial pressures at admission and postpartum, lower platelet counts, and elevated liver enzyme values. D-dimer-positive women also had infants with significantly lower birth weight and lower Apgar scores. After delivery, those with a positive D-dimer test were at risk for even greater abnormalities of liver enzymes, as well as lower platelet counts. Abnormalities of any of these laboratory parameters were unlikely in the presence of a negative D-dimer test result (negative predictive value = 0.89). Our results suggest that D-dimer-positive preeclamptic women are at high risk of having HELLP syndrome and should receive close follow-up, whereas D-dimer-negative patients are unlikely to have this disorder and tend to have a better maternal-fetal outcome.
