A 29-year-old G2 P1001 in her third trimester presents to the clinic for a routine check up. You take her vitals and note that her blood pressure is elevated to 150/95. On interview, she complains about some mild RUQ pain that she has had for the last few days. You confirm this on physical exam and also take note of facial puffiness. A urine dipstick in the office shows 3+ proteinuria. What are the laboratory features of the particular syndrome this patient has likely developed?
Elevated BUN and elevated creatinine
Elevated fasting glucose level and elevated liver enzymes
Low platelet count and elevated liver enzymes
Low platelet count and elevated magnesium level
Low white blood cell count and elevated liver enzymes
Correct answer
Low platelet count and elevated liver enzymes
Explanation:
The combination of hypertension, proteinuria and nondependent edema in a pregnant woman should immediately make you think about preeclampsia. The presence of right upper quadrant (RUQ) pain further suggests the development of HELLP syndrome, which occurs in about 10% of patients with preeclampsia. HELLP syndrome is Hemolysis, elevated LFTs, and low platelets. Thus, you definitely want to check the platelet count and the LFTs in this scenario.
WBC count would be helpful if you suspected an infection, but this is not the most likely diagnosis at this time. Magnesium sulfate is used for seizure prophylaxis in women with preeclampsia (ie, to avoid eclampsia).
Renal failure can occur in preeclampsia, but checking renal function alone is not the best initial step.
Diabetic women are at an increased risk of developing preeclampsia if they become pregnant. However, measuring the fasting glucose level would not help diagnose preeclampsia or the HELLP syndrome.
Note: G2 P1001 tells us that the patient has been pregnant (G = gravida) twice. She has had 1 full term birth, 0 preterm births, 0 abortions (spontaneous or induced), and has 1 living child. Thus she is P, or para, 1-0-0-1. The mnemonic for this is F-P-A-L (Full term, Preterm, Abortions, Living children).