Naslov
Klinička prezentacija HELLP sindroma
(HEELP Syndrome Clinical Presentation)

Autori
Šola, Magdalena

Vrsta, podvrsta i kategorija rada
Ocjenski radovi, diplomski rad, diplomski

Fakultet
Medicinski fakultet

Mjesto
Zagreb

Datum
14.07

Godina
2011

Stranica
20

Mentor
Degoricija, Vesna

Ključne riječi
HELLP sindrom; preeklampsija; komplikacija trudnoće
(HELLP syndrome; preeclampsia; pregnancy complications)

Sažetak
Sindrom karakteriziran hemolizom, porastom jetrenih enzima i trombocitopenijom ili HELLP sindrom poremećaj je koji je povezan s trudnoćom. U 70 % bolesnica javlja se u trećem trimestru trudnoće, odnosno u 30 % slučajeva postpartalno. Može se javiti kao samostalan poremećaj ili u sklopu preeklampsije. Patogeneza HELLP sindroma nije u potpunosti poznata, smatra se da važnu ulogu u patogenezi imaju promjena imunog feto- maternalnog balansa, endotelna disfunkcija s agregacijom trombocita i urođena pogreška metabolizma masnih kiselina. Opisani su laboratorijski kriteriji za dijagnosticiranje HELLP sindroma, temeljeni na perifernom razmazu krvi, razini indirektnog bilirubina, serumskog haptoglobina, povišenim razinama jetrenih enzima i sniženoj koncentraciji trombocita, međutim niti jedan nije samodostatan. Prepoznavanje HELLP sindroma obično je karakterizirano kombinacijom kliničke slike praćene bolovima u epigastriju i/ili u gornjem desnom abdominalnom kvadrantu, slabošću, mučninom i povraćanjem te laboratorijskim nalazima. Zbog nespecifičnosti simptoma i sličnosti s drugim bolestima i poremećajima, dijagnoza HELLP sindroma obično je otežana i odgođena. Najvažnije komplikacije jesu diseminirana intravaskularna koagulacija (DIK), abrupcija placente i teško postpartalno krvarenje koji značajno povisuju mortalitet. Liječenje HELLP sindroma mora biti agresivno s primjenom visokih doza kortikosteroida te praćeno brzim porođajem kako bi rezultiralo što manjim maternalnim i perinatalnim mortalitetom. Unatoč već gotovo 30- godišnjem poznavanju ovog sindroma, jedini pravi lijek jest porođaj.

Izvorni jezik
Hrvatski

Znanstvena područja
Kliničke medicinske znanosti

Napomena
HELLP syndrome is a disorder characterized by haemolysis, increase of liver enzymes and thrombocytopenia that is associated with pregnancy. In 70 % of patients occurs in the third trimester and in 30% of cases occurs in the post partum period. It can present itself as an independent disorder or as a part of preeclampsia. Although pathogenesis of the HELLP syndrome is still not entirely familiar, it is considered that changes of immune feto-maternal balance, endothelial dysfunction winth aggregation of thrombocytes and congenital defects of fatty acid metabolism play an important role in the origin of this disorder. Laboratory criteria required for diagnosis of HELLP syndrome are based on peripheral blood smear, indirect bilirubin values, serum haptoglobin, increased values of liver enzymes and reduced concentration of thrombocytes, although none of them are self-sufficient in determining this syndrome. Therefore, a final diagnosis is made by a combination of laboratory findings and clinical manifestations which include pain in the epigastrium and/or upper right abdominal quadrant, fatigue, nausea and vomiting. Unspecific symptoms and similarity with other diseases and medical conditions make the diagnostic process difficult and may lead to a late diagnosis. Complications that may occur are disseminated intravascular coagulation (DIC), placental abruption and grave postpartal haemorrhage that increase mortality significantly. Treatment of HELLP syndrome has to be aggresive with high dose of cortisteroids shortly followed by parturition, so as to minimize maternal and perinatal mortality. Despite the fact that this syndrome has been known for almost thirty years, still the only true medicine is parturition.

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