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Differentiation of acute fatty liver of pregnancy from syndrome of hemolysis, elevated liver enzymes and low platelet counts

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Title: Differentiation of acute fatty liver of pregnancy from syndrome of hemolysis, elevated liver enzymes and low platelet counts
Authors: Minakami, Hisanori Browse this author →KAKEN DB
Morikawa, Mamoru Browse this author →KAKEN DB
Yamada, Takahiro Browse this author →KAKEN DB
Yamada, Takashi Browse this author →KAKEN DB
Akaishi, Rina Browse this author
Nishida, Ryutaro Browse this author
Keywords: antithrombin activity
blood vessel permeability
liver dysfunction
Issue Date: Mar-2014
Publisher: Wiley-Blackwell
Journal Title: Journal of Obstetrics and Gynaecology Research
Volume: 40
Issue: 3
Start Page: 641
End Page: 649
Publisher DOI: 10.1111/jog.12282
PMID: 24428400
Abstract: As proposed criteria (Swansea criteria) for the diagnosis of acute fatty liver of pregnancy (AFLP) do not include antithrombin (AT) activity, diagnosis of AFLP may be delayed. The aim of this review is to underscore problems in the differential diagnosis of AFLP and the syndrome of hemolysis, elevated liver enzymes and low platelet counts (HELLP syndrome) and to facilitate prompt diagnosis of AFLP. Published works dealing with liver dysfunction in pregnancy, HELLP syndrome and AFLP were reviewed. AFLP and HELLP syndrome shared common clinical, laboratory, histological and genetic features, and differential diagnosis between them was often difficult. However, HELLP syndrome was likely to occur in patients with hypertension, but AFLP occurred often in the absence of hypertension. In addition, AFLP was exclusively associated with pregnancy-induced antithrombin deficiency (PIATD). Approximately 50% of patients with AFLP did not have thrombocytopenia at presentation. As the Swansea criteria for AFLP did not include PIATD, diagnosis of AFLP was delayed until manifestation of life-threatening complications; 60% of women were admitted to intensive care and 15% to a specialist liver unit. In conclusion, incorporation of AT activity of less than 65% into the diagnostic criteria for AFLP may facilitate suspicion and prompt diagnosis of AFLP, decrease uncertainty regarding the diagnosis of AFLP, and contribute to better investigation and understanding of the process leading to the development of liver dysfunction.
Rights: The definitive version is available at Wiley Online Library ,
Type: article (author version)
Appears in Collections:医学院・医学研究院 (Graduate School of Medicine / Faculty of Medicine) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

Submitter: 水上 尚典

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