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Change in platelet count predicts eventual maternal outcome with syndrome of hemolysis, elevated liver enzymes and low platelet count

Objective : To profile the rates of change for platelets and lactate dehydrogenase (LDH) in patients with the syndrome of hemolysis, elevated liver enzymes and low platelet count (HELLP) to reflect and possibly predict disease severity. Methods : Serial determinations of the platelet count and serum LDH were analyzed retrospectively for 545 patients with HELLP syndrome and 94 severely pre-eclamptic patients. A repeated measures (mixed model) analysis of variance (ANOVA) was utilized to estimate the rates of change for LDH and platelets in each group. Results : Patients who developed class 1 or 2 HELLP syndrome exhibited a rapid deterioration in platelet count of 45-50 000/ w l per day compared to 30 000/ w l per day for class 3 and non-HELLP severe pre-eclampsia. For LDH, values increased at a rate of approximately 1400 IU/l per day, 600 IU/l per day, 300 IU/l per day and 200 IU/l per day for patients with classes 1, 2 and 3 and for non-HELLP severe pre-eclampsia, respectively. Conclusion : The rate of change of platelets and LDH appeared to correlate well with eventual syndrome severity and this can be used to enhance patient assessment beyond the value of a single test for either laboratory parameter.