Background and Aims A 32-year-old G1P01 at 36-weeks-3-days with a history of alcohol and opioid abuse, asthma, gestational hypertension presented with severe pre-eclampsia(SP) by blood pressure criteria. The patient refused a trial of induction of labor and was scheduled for Cesarean section (CS) under neuraxial anesthesia. Her blood workup was normal 10 hours prior to her CS. A repeat workup showed normal platelet count (314k/ul), elevated INR (2.8), PTT (45.4), lactate (3.5mmol/L), and low fibrinogen (215mg/dL) levels. Thrombo-elastography was also normal. The surgery was postponed and a diagnosis of acute fatty liver of pregnancy (AFLP) with superimposed pre-eclampsia was confirmed by clinical, laboratory, and imaging features.
Methods Hematological abnormalities such as thrombocytopenia and decrease in clotting factors may develop in pre-eclamptic women. The risk of abnormal hemostasis increases with the severity of pre-eclampsia.
Results Platelet count is routinely used as a primary test to evaluate the coagulation status in parturients with SP 1. It has been shown that when the platelet count < 100,000/mm3, other hemostatic abnormalities, such as prolonged prothrombin time (PT) and partial thromboplastin time (PTT), and reduced fibrinogen concentration, may also be presented 2. About 50% of patients with AFLP have preeclampsia, and there is some overlap with the HELLP syndrome 3.
Conclusions This case highlights that in parturients with SP, the platelet count should not be used as the sole mean to evaluate the coagulation status, as there are conditions such as acute fatty liver of pregnancy and viral-hepatitis that can mimic or overlap pre-eclampsia in the absence of thrombocytopenia.
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