Download PDF
CC BY-NC-ND 4.0 · AJP Rep 2020; 10(02): e179-e182
DOI: 10.1055/s-0040-1712978
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

COVID-19 and HELLP: Overlapping Clinical Pictures in Two Gravid Patients

Itamar Futterman
1   Department of Obstetrics and Gynecology, New York Medical College, Valhalla, New York
,
Miriam Toaff
1   Department of Obstetrics and Gynecology, New York Medical College, Valhalla, New York
,
Liel Navi
1   Department of Obstetrics and Gynecology, New York Medical College, Valhalla, New York
,
Camille A. Clare 
1   Department of Obstetrics and Gynecology, New York Medical College, Valhalla, New York
› Author Affiliations
Further Information

Publication History

01 May 2020

02 May 2020

Publication Date:
18 June 2020 (online)

   Permissions and Reprints

Abstract

Background The impact of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) on pregnancies is currently under investigation. There is a significant overlap between the clinical findings in novel coronavirus disease 2019 (COVID-19) and hemolysis, elevated liver enzymes, and low platelets syndrome (HELLP).

Cases Patients presented at 22 and 29 weeks of gestation with suspected COVID-19 pneumonia. While the patient at 22 weeks of gestation subsequently had an intrauterine fetal demise, the patient at 29 weeks of gestation delivered via an emergency cesarean delivery for nonreassuring fetal status. Both patients also developed transaminitis, thrombocytopenia, and disseminated intravascular coagulation with a proof of hemolysis on peripheral smear.

Conclusion Clinicians are encouraged to consider both of these diagnoses when caring for pregnant women during the COVID-19 pandemic to assure that both maternal and fetal concerns are addressed and treated appropriately.

Keywords

COVID-19 - HELLP - pregnancy - overlapping conditions
 

  • References

  • 1 White WM, Tran D, Garovic VD, Brost B. Acute interstitial nephritis proteinuria and herpes simplex virus hepatitis in pregnancy mimic HELLP syndrome (hemolysis, elevated liver enzymes, low platelets). AJP Rep 2011; 1 (02) 115-118
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Khangura RK, Williams N, Cooper S, Prabulos AM. Babesiosis in pregnancy: an imitator of HELLP syndrome. AJP Rep 2019; 9 (02) e147-e152
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Stone JH. HELLP syndrome: hemolysis, elevated liver enzymes, and low platelets. JAMA 1998; 280 (06) 559-562
    CrossrefPubMedGoogle Scholar
  • 4 Sibai BM. Diagnosis, controversies, and management of the syndrome of hemolysis, elevated liver enzymes, and low platelet count. Obstet Gynecol 2004; 103 (5, Pt 1): 981-991
    CrossrefPubMedGoogle Scholar
  • 5 Stella CL, Malik KM, Sibai BM. HELLP syndrome: an atypical presentation. Am J Obstet Gynecol 2008; 198 (05) e6-e8
    CrossrefPubMedGoogle Scholar
  • 6 Lake MA. What we know so far: COVID-19 current clinical knowledge and research. Clin Med (Lond) 2020; 20 (02) 124-127
    PubMedGoogle Scholar
  • 7 Chen H, Guo J, Wang C. , et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet 2020; 395 (10226): 809-815
    CrossrefPubMedGoogle Scholar
  • 8 Schnettler WT, Al Ahwel Y, Suhag A. Severe ARDS in COVID-19-infected pregnancy: obstetric and intensive care considerations. Am J Obstet Gynecol MFM 2020; 100120
    PubMedGoogle Scholar
  • 9 Haram K, Svendsen E, Abildgaard U. The HELLP syndrome: clinical issues and management. A review. BMC Pregnancy Childbirth 2009; 9: 8
    CrossrefPubMedGoogle Scholar
  • 10 Rao D, Chaudhari NK, Moore RM, Jim B. HELLP syndrome: a diagnostic conundrum with severe complications. BMJ Case Rep 2016; 2016 DOI: 10.1136/bcr-2016-216802.
    CrossrefPubMedGoogle Scholar
  • 11 Lillicrap D. Disseminated intravascular coagulation in patients with 2019-nCoV pneumonia. J Thromb Haemost 2020; 18 (04) 786-787
    CrossrefPubMedGoogle Scholar
  • 12 Boettler T, Newsome PN, Mondelli MU. , et al. Care of patients with liver disease during the COVID-19 pandemic: EASL-ESCMID position paper. JHEP Rep 2020; 2 (03) 100113
    CrossrefPubMedGoogle Scholar
  • 13 Guo T, Fan Y, Chen M. , et al. Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19). JAMA Cardiol 2020; (e-pub ahead of print) DOI: 10.1001/jamacardio.2020.1017.
    CrossrefPubMedGoogle Scholar
  • 14 Matthay MA, Aldrich JM, Gotts JE. Treatment for severe acute respiratory distress syndrome from COVID-19. Lancet Respir Med 2020; 8 (05) 433-434
    CrossrefPubMedGoogle Scholar
  • 15 Huang C, Wang Y, Li X. , et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395 (10223): 497-506
    CrossrefPubMedGoogle Scholar
  • 16 Li Q, Guan X, Wu P. , et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med 2020; 382 (13) 1199-1207
    CrossrefPubMedGoogle Scholar
  • 17 Kline JA, Williams GW, Hernandez-Nino J. D-dimer concentrations in normal pregnancy: new diagnostic thresholds are needed. Clin Chem 2005; 51 (05) 825-829
    CrossrefPubMedGoogle Scholar
  • 18 van der Pol LM, Tromeur C, Bistervels IM. , et al; Artemis Study Investigators. Pregnancy-adapted YEARS algorithm for diagnosis of suspected pulmonary embolism. N Engl J Med 2019; 380 (12) 1139-1149
    CrossrefPubMedGoogle Scholar
  • 19 Yoon SH, Lee KH, Kim JY. , et al. Chest radiographic and CT findings of the 2019 novel coronavirus disease (COVID-19): analysis of nine patients treated in Korea. Korean J Radiol 2020; 21 (04) 494-500
    CrossrefPubMedGoogle Scholar
  • 20 Mai C, Wang B, Chen R. , et al. HELLP syndrome complicated by pulmonary edema: a case report. Open Med (Wars) 2018; 13 (01) 509-511
    PubMedGoogle Scholar