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Preeclampsia easily confused with a wide range of syndromes: Acute Fatty Liver, Thrombophilias.

PALM BEACH, FLA. -- The clinical presentation of a range of medical syndromes can easily be confused with that of severe preeclampsia, Dr. Baha Sibai said at the annual meeting of District V of the American College of Obstetricians and Gynecologists.

While several conditions share a range of signs and symptoms with preeclampsia, each has some distinguishing characteristics or lab results, said Dr. Sibai, an internationally recognized expert in preeclampsia at the University of Cincinnati.

Knowing what to look for is the key to making a differential diagnosis. Keep in mind that preeclampsia is an ischemic disease and the disseminated intravascular coagulation of preeclampsia usually resolves within 24 hours of delivery, while some of the conditions that mimic it are metabolic and many continue long after, he advised.

* Acute fatty liver of pregnancy (AFL). This is a metabolic disorder that typically develops between 27 and 41 weeks' gestation. Its signs and symptoms include epigastric or right upper quarter pain; malaise, often accompanied by nausea or vomiting; diarrhea and jaundice; reduced fetal movement; vaginal or GI bleeding; and low-grade fever. Patients with AFL lose weight and become dehydrated--the exact opposite of what occurs with preeclampsia, Dr. Sibai said. Distinguishing lab results include a liver function test showing an increase in lactic dehydrogenase, a normal platelet count, and elevated creatinine. In addition, patients will have low fibrinogen and prolonged pro-thrombin time and partial thromboplastin time, which is never the case with preeclampsia without abruption.

* Thrombotic thrombocytic purpura (TTP) and hemolytic uremic syndrome (HUS). These conditions have both been mistaken for preeclampsia. TTP has a prepartum or early postpartum onset. Patients develop severe renal impairment and transient but recurrent neurologic changes. Indicators include severe hematuria, weakness and fever, and ecchymoses or purpura. "You see red urine," he said. But hemolytic anemia, thrombocytopenia, and the CNS manifestations are the keys to diagnosis. Plasmapheresis, the treatment of choice, can significantly reduce the risk of mortality, but relapse is likely, Dr. Sibai added.

HUS, unlike preeclampsia, almost always develops post partum, typically within the first 4 weeks. It, too, is characterized by thrombocytopenia and hemolytic anemia and, notably severe renal failure. Dialysis is always required, and a residual renal deficit virtually always remains.

* Exacerbation of lupus. This may be mistaken for severe preeclampsia initially but its clinical presentation has several distinguishing indicators that are evident on closer look. In addition to hypertension, proteinuria, and fever, patients may present with pleuritis or pneumonitis, cerebral vasculopathy, and lupus hepatitis. High-dose prednisone, immune suppressants, and intravenous gamma globulin are recommended treatments, Dr. Sibai said.

* Thrombophilias. Thrombophilias may be benign and require no prenatal treatment. Others, particularly some congenital thrombophilias, can result in a clinical presentation that closely resembles that of severe preeclampsia. In fact, preeclampsia is one of a number of adverse outcomes associated with certain thrombophilias. Long-term anticoagulation therapy is recommended for patients at high risk.

* Herpes simplex hepatitis. This is one of the most dangerous of the conditions that mimic preeclampsia. Herpes lesions and encephalitis occur in about half of obstetrical patients with this condition, and nearly two-thirds develop disseminated intravascular coagulation. Intravenous acyclovir is the treatment of choice.
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Author:Lippman, Helen
Publication:OB GYN News
Date:Jan 15, 2002
Previous Article:Alloimmune Thrombocytopenia: Tx and diagnosis. (Gamma Globulin Effective).
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