Delayed Postpartum Hemolysis, Elevated Liver Enzymes, and Low Platelets Syndrome Successfully Treated with Dexamethasone

Tae Hee Kim; Namkyeong Kim; Jee Yoon Park; Kyung Joon Oh; Joon-Seok Hong

doi:10.14734/PN.2018.29.03.138

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Kim, Kim, Park, Oh, and Hong: Delayed Postpartum Hemolysis, Elevated Liver Enzymes, and Low Platelets Syndrome Successfully Treated with Dexamethasone

Case report

Perinatology 2018;29(3):138-141.

Published online: 19 September 2018

DOI: https://doi.org/10.14734/PN.2018.29.03.138

Delayed Postpartum Hemolysis, Elevated Liver Enzymes, and Low Platelets Syndrome Successfully Treated with Dexamethasone

Tae Hee Kim, MD, Namkyeong Kim, MD, Jee Yoon Park, MD, Kyung Joon Oh, PhD, Joon-Seok Hong, PhD

Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea

Correspondence to Jee Yoon Park, MD Department of Obstetrics and Gynecology Seoul National University Bundang Hospital, 82 Gumi-ro, 173 beon-gil, Bundang-gu, Seongnam 13620, Korea Tel: +82-31-787-7266 Fax: +82-31-787-4054 E-mail: jyparkmd08@snu.ac.kr

Received 19 February 201826 April 2018 Accepted 20 July 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The treatment of choice for preeclampsia is delivery. However, delivery is not always the end of preeclampsia. We present a case of preeclampsia complicated by postpartum hemolysis, elevated liver enzymes, and low platelets syndrome 30 hours after delivery and treated by high dose steroid. A 34-year-old pregnant woman with severe preeclampsia at 35 weeks of gestation was admitted for close observation. All antenatal laboratory studies performed showed no abnormality. Due to un controlled blood pressure and severe headache, induction of labor was decided and successful vaginal delivery was accomplished. On the second day of postpartum period, upper abdominal pain developed and laboratory studies including liver enzymes and platelets suddenly became abnormal. On the next day, liver enzymes and platelet count were far more aggravated. To stop progression, intravenous dexamethasone (10 mg) was administered at 46 hours postpartum. Liver enzymes and platelet counts recovered immediately after administration of steroid.

Keywords: Dexamethasone, HELLP syndrome, Postpartum period, Preeclampsia

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Fig. 1

Changes in laboratory results over time. AST, aspartate transaminase; ALT, alanine transaminase; Plt, platelets.

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