Coagulation and plasma fibronectin parameters in HELLP syndrome

Area of Science:

• Obstetrics and Gynecology
• Hematology
• Pathophysiology

Background:

• HELLP syndrome (hemolysis, elevated liver enzymes, low platelets) presents significant maternal and fetal risks.
• Late diagnosis of HELLP syndrome contributes to its high morbidity and mortality.
• Identifying early diagnostic markers for endothelial damage and coagulation activation is crucial.

Purpose of the Study:

• To investigate natural coagulation inhibitors, fibronectin, and haptoglobin as potential early diagnostic markers for HELLP syndrome.
• To assess changes in these markers to detect endothelial damage and intravascular hemolysis.
• To differentiate HELLP syndrome from conventional preeclampsia.

Main Methods:

• Comparative study involving 17 controls, 19 preeclampsia patients, and 11 HELLP syndrome patients.
• Assessed antithrombin (AT-III), protein C, protein S activity, plasma fibronectin, prothrombin time, partial prothrombin time, AST, ALT, LDH, bilirubin, and serum haptoglobin.
• Analyzed coagulation parameters and hemolysis markers.

Main Results:

• HELLP syndrome patients exhibited higher fibronectin and D-dimer levels, and lower AT-III and protein C activity compared to controls.
• Lower platelet counts and elevated LDH were observed in HELLP syndrome patients.
• Serum haptoglobin was significantly lower in HELLP syndrome, with only 25% showing elevated bilirubin.

Conclusions:

• HELLP syndrome likely involves a pro-coagulatory imbalance in placental microcirculation.
• Endothelial damage and coagulation cascade activation are triggered by tissue thromboplastin release and collagen exposure.
• Measuring plasma fibronectin, coagulation inhibitors, and haptoglobin can aid in differentiating HELLP syndrome from preeclampsia.