Plasmapheresis for acute liver failure in acute fatty liver of pregnancy

2017 ◽  
Vol 17 (3) ◽  
pp. 222-225
Author(s):  
Karla Gabriela Peniche-Moguel ◽  
Jesús Salvador Sánchez-Díaz ◽  
César López-Guzmán ◽  
María Verónica Calyeca-Sánchez ◽  
Edgar Castañeda-Valladares
Keyword(s):  
Liver Failure ◽  
Fatty Liver ◽  
Acute Liver Failure ◽  
Acute Fatty Liver

scholarly journals HELLP Syndrome or Acute Fatty Liver of Pregnancy: A Differential Diagnostic Challenge

2020 ◽  
Vol 80 (05) ◽  
pp. 499-507
Author(s):  
Werner Rath ◽  
Panagiotis Tsikouras ◽  
Patrick Stelzl
Keyword(s):  
Liver Failure ◽  
Fatty Liver ◽  
Acute Liver Failure ◽  
Hellp Syndrome ◽  
Multiple Pregnancy ◽  
Rapid Progression ◽  
Laboratory Findings ◽  
Mitochondrial Fatty Acid ◽  
Increased Risk ◽  
Acute Fatty Liver

AbstractHELLP syndrome and the less common acute fatty liver of pregnancy (AFL) are unpredictable, life-threatening complications of pregnancy. The similarities in their clinical and laboratory presentations are often challenging for the obstetrician when making a differential diagnosis. Both diseases are characterised by microvesicular steatosis of varying degrees of severity. A specific risk profile does not exist for either of the entities. Genetic defects in mitochondrial fatty acid oxidation and multiple pregnancy are considered to be common predisposing factors. The diagnosis of AFL is based on a combination of clinical symptoms and laboratory findings. The Swansea criteria have been proposed as a diagnostic tool for orientation. HELLP syndrome is a laboratory diagnosis based on the triad of haemolysis, elevated aminotransferase levels and a platelet count < 100 G/l. Generalised malaise, nausea, vomiting and abdominal pain are common symptoms of both diseases, making early diagnosis difficult. Clinical differences include a lack of polydipsia/polyuria in HELLP syndrome, while jaundice is more common and more pronounced in AFL, there is a lower incidence of hypertension and proteinuria, and patients with AFL may develop encephalopathy with rapid progression to acute liver failure. In contrast, neurological symptoms such as severe headache and visual disturbances are more prominent in patients with HELLP syndrome. In terms of laboratory findings, AFL can be differentiated from HELLP syndrome by the presence of leucocytosis, hypoglycaemia, more pronounced hyperbilirubinemia, an initial lack of haemolysis and thrombocytopenia < 100 G/l, as well as lower antithrombin levels < 65% and prolonged prothrombin times. While HELLP syndrome has a fluctuating clinical course with rapid exacerbation within hours or transient remissions, AFL rapidly progresses to acute liver failure if the infant is not delivered immediately. The only causal treatment for both diseases is immediate delivery. Expectant management between 24 + 0 and 33 + 6 weeks of gestation is recommended for HELLP syndrome, but only in cases where the mother can be stabilised and there is no evidence of foetal compromise. The maternal mortality rate for HELLP syndrome in developed countries is approximately 1%, while the rate for AFL is 1.8 – 18%. Perinatal mortality rates are 7 – 20% and 15 – 20%, respectively. While data on the long-term impact of AFL on the health of mother and child is still insufficient, HELLP syndrome is associated with an increased risk of developing cardiovascular, metabolic and neurological diseases in later life.

Acute Liver Failure in an Obstetric Patient: Challenge of Critical Care for 1 Patient With 2 Subspecialty Needs

2013 ◽  
Vol 33 (1) ◽  
pp. 48-56 ◽  
Author(s):  
Holly Castello ◽  
Lisa Schoch ◽  
Tracy A. Grogan
Keyword(s):  
Critical Care ◽  
Liver Failure ◽  
Fatty Liver ◽  
Acute Liver Failure ◽  
Acid Metabolism ◽  
Medical Specialties ◽  
Life Threatening ◽  
Acute Fatty Liver ◽  
Prompt Diagnosis

Acute fatty liver of pregnancy is a rare and life-threatening disease associated with a defect in fatty acid metabolism in the fetus that causes liver disease in the mother. Prompt diagnosis and management are critical to the outcome of both the mother and the fetus and require involvement of several medical specialties, including hepatology, obstetrics, and, possibly, critical care. The included case study describes a woman with acute fatty liver of pregnancy decompensating to acute liver failure complicated by encephalopathy, cerebral edema, and intracranial hypertension. Subsequent management of these conditions, including the woman’s progression to liver transplant, is provided.

scholarly journals Liver Transplantation for Acute Liver Failure at 11-Week Gestation with Successful Maternal and Fetal Outcome

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Vinaya C. Maddukuri ◽  
Courtney D. Stephenson ◽  
Lon Eskind ◽  
William A. Ahrens ◽  
Preston Purdum ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Liver Enzymes ◽  
First Trimester ◽  
Fetal Outcome ◽  
Third Trimester ◽  
Elevated Liver Enzymes ◽  
Acute Fatty Liver ◽  
First Trimester Of Pregnancy

Acute liver failure (ALF) during pregnancy is very uncommon. Pregnancy-specific liver conditions like hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome and acute fatty liver of pregnancy can cause ALF at term or postpartum, but, typically occur during the third trimester. Most of these patients recover spontaneously after delivery, but, on occasion, they require liver transplantation in the postpartum period. However, ALF during the first and second trimester of pregnancy requiring antepartum liver transplantation is rare. Only fifteen cases of liver transplantation during pregnancy have been reported, and very few occurred during the first trimester. We report a Woman who developed acute liver failure during the first trimester of pregnancy and underwent successful liver transplantation at 11-week gestation, followed by successful delivery of the fetus at 30 weeks. To our knowledge, this is the earliest case of successful liver transplantation during pregnancy followed by successful fetal outcome. We discuss management of the patient and fetus before, during, and after liver transplantation and review the literature on antepartum liver transplant in pregnancy.

Reversible peripartum liver failure: A new perspective on the diagnosis, treatment, and cause of acute fatty liver of pregnancy, based on 28 consecutive cases

1999 ◽  
Vol 181 (2) ◽  
pp. 389-395 ◽  
Author(s):  
Mary A. Castro ◽  
Michael J. Fassett ◽  
Telfer B. Reynolds ◽  
Kathryn J. Shaw ◽  
T.Murphy Goodwin
Keyword(s):  
Liver Failure ◽  
Fatty Liver ◽  
Acute Fatty Liver ◽  
New Perspective
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