© Springer International Publishing AG 2017
Tilak D. Raj (ed.)Data Interpretation in Anesthesiahttps://doi.org/10.1007/978-3-319-55862-2_4141. CBC/Chemistries II
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Department of Anesthesiology, University of Oklahoma Health Sciences Center, 750 NE 13th Street, Suite 200, Oklahoma City, OK 73104, USA
Keywords
PreeclampsiaHELLPProteinuriaThrombocytopeniaDICA 27-year-old G4P3 presented to antepartum clinic with high blood pressure and epigastric pain. On physical examination the patient had mild epigastric tenderness and 2+ edema over both lower extremities.
Vital signs: BP 170/120 mmHg, HR 90 bpm, RR 20 bpminute, SpO2 95% on room air
Hb 11 mg/dL
Hct 33
Platelets 90 K
Creatinine >1.2 mg/dL
Billirubin >1.2 mg/mL
Uric acid >6 mg/mL
LDH >600 IU/L
Elevated AST/ALT
Proteinuria >0.3 g in a 24 h urine specimen
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What laboratory work-up is needed to confirm your diagnosis?
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How will you differentiate mild vs severe forms of the condition based on proteinuria?
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What is important to look for in the complete blood count (CBC)?
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How are blood urea nitrogen (BUN), creatinine, and uric acid levels affected in this condition?
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Is the epigastric pain significant in this patient?
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What is HELLP syndrome and what are some of the diagnostic criteria?
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What will you look for in the DIC panel?
Answers
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Complete blood cell count (CBC), serum electrolytes, blood urea nitrogen, creatinine, liver function test, serum uric acid, urine analysis—microscopic and 24 h specimen for protein and creatinine clearance. According to the American Congress of Obstetricians and Gynecologists (ACOG) practice bulletin in 2002, preeclampsia is defined as the new onset of hypertension and proteinuria after 20 weeks’ gestation [1]. Proteinuria is a key factor in order to differentiate preeclampsia vs gestational hypertension and chronic hypertension in pregnancy. However in 2013 ACOG guidelines, proteinuria was removed from the diagnostic criteria of preeclampsia as it is nonspecific and doesn’t always correlate with maternal and fetal outcomes. ACOG has suggested that any parturient with new-onset hypertension at 20 weeks of pregnancy or beyond, along with either of the following conditions, should be diagnosed with preeclampsia even in the absence of proteinuria.
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