Hemostatic dysfunction with acute fatty liver of pregnancy

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

OBJECTIVE:: To estimate the frequency of disseminated intravascular coagulation (DIC); elucidate the genesis of hemostatic dysfunction; and characterize associated hemolysis in women with acute fatty liver of pregnancy. METHODS:: Hemostatic function was measured in 51 women. Disseminated intravascular coagulation was assessed using the International Society of Thrombosis and Haemostasis DIC score. Hepatic and hemostatic function was quantified with measurement of fibrinogen, fibrin-fibrinogen split products, cholesterol, and coagulation testing. As a comparison of fibrinogen synthesis, these women were compared with 25 women with placental abruption. Hemolysis was assessed indirectly by quantification of reticulocytosis and nucleated red blood cells with determination of erythrocyte morphotypes. RESULTS:: Eighty-percent of women were classified as having unequivocal DIC (mean score 5.9±1.8) at delivery, which persisted 4-5 days postpartum. Fibrinogen regeneration with placental abruption was rapid, whereas it remained depressed for 4-5 days with acute fatty liver of pregnancy; fibrin-fibrinogen split products were also cleared more rapidly after abruption than women with acute fatty liver (P<.001 for interaction for both using random effects modeling). Kaplan-Meier survival analysis of fibrinogen recovery to a set point of 280 mg/dL after delivery was also different between the two cohorts (median 1.7 compared with 4.2 days, P=.046). Continuing hepatic dysfunction with acute fatty liver of pregnancy was exemplified by diminished procoagulant production. Reticulocytosis, nucleated red blood cells, and elevated serum bilirubin levels reflected ongoing hemolysis. CONCLUSIONS:: Hemostatic dysfunction with acute fatty liver of pregnancy persists 4-5 days postpartum and results from substantive ongoing DIC in concert with reduced procoagulant synthesis and clinically significant hemolysis.

Original languageEnglish (US)
Pages (from-to)40-46
Number of pages7
JournalObstetrics and Gynecology
Volume124
Issue number1
DOIs
StatePublished - 2014

Fingerprint

Hemostatics
Disseminated Intravascular Coagulation
Hemolysis
Fibrinogen
Reticulocytosis
Abruptio Placentae
Fibrin Fibrinogen Degradation Products
Erythrocytes
Postpartum Period
Liver
Kaplan-Meier Estimate
Fatty Liver
Survival Analysis
Hemostasis
Bilirubin
Acute fatty liver of pregnancy
Regeneration
Thrombosis
Cholesterol
Serum

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Hemostatic dysfunction with acute fatty liver of pregnancy. / Nelson, David B.; Yost, Nicole P.; Cunningham, F. Gary.

In: Obstetrics and Gynecology, Vol. 124, No. 1, 2014, p. 40-46.

Research output: Contribution to journalArticle

@article{84881cbbfbfd46a583dbaadfaf7c996f,
title = "Hemostatic dysfunction with acute fatty liver of pregnancy",
abstract = "OBJECTIVE:: To estimate the frequency of disseminated intravascular coagulation (DIC); elucidate the genesis of hemostatic dysfunction; and characterize associated hemolysis in women with acute fatty liver of pregnancy. METHODS:: Hemostatic function was measured in 51 women. Disseminated intravascular coagulation was assessed using the International Society of Thrombosis and Haemostasis DIC score. Hepatic and hemostatic function was quantified with measurement of fibrinogen, fibrin-fibrinogen split products, cholesterol, and coagulation testing. As a comparison of fibrinogen synthesis, these women were compared with 25 women with placental abruption. Hemolysis was assessed indirectly by quantification of reticulocytosis and nucleated red blood cells with determination of erythrocyte morphotypes. RESULTS:: Eighty-percent of women were classified as having unequivocal DIC (mean score 5.9±1.8) at delivery, which persisted 4-5 days postpartum. Fibrinogen regeneration with placental abruption was rapid, whereas it remained depressed for 4-5 days with acute fatty liver of pregnancy; fibrin-fibrinogen split products were also cleared more rapidly after abruption than women with acute fatty liver (P<.001 for interaction for both using random effects modeling). Kaplan-Meier survival analysis of fibrinogen recovery to a set point of 280 mg/dL after delivery was also different between the two cohorts (median 1.7 compared with 4.2 days, P=.046). Continuing hepatic dysfunction with acute fatty liver of pregnancy was exemplified by diminished procoagulant production. Reticulocytosis, nucleated red blood cells, and elevated serum bilirubin levels reflected ongoing hemolysis. CONCLUSIONS:: Hemostatic dysfunction with acute fatty liver of pregnancy persists 4-5 days postpartum and results from substantive ongoing DIC in concert with reduced procoagulant synthesis and clinically significant hemolysis.",
author = "Nelson, {David B.} and Yost, {Nicole P.} and Cunningham, {F. Gary}",
year = "2014",
doi = "10.1097/AOG.0000000000000296",
language = "English (US)",
volume = "124",
pages = "40--46",
journal = "Obstetrics and Gynecology",
issn = "0029-7844",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Hemostatic dysfunction with acute fatty liver of pregnancy

AU - Nelson, David B.

AU - Yost, Nicole P.

AU - Cunningham, F. Gary

PY - 2014

Y1 - 2014

N2 - OBJECTIVE:: To estimate the frequency of disseminated intravascular coagulation (DIC); elucidate the genesis of hemostatic dysfunction; and characterize associated hemolysis in women with acute fatty liver of pregnancy. METHODS:: Hemostatic function was measured in 51 women. Disseminated intravascular coagulation was assessed using the International Society of Thrombosis and Haemostasis DIC score. Hepatic and hemostatic function was quantified with measurement of fibrinogen, fibrin-fibrinogen split products, cholesterol, and coagulation testing. As a comparison of fibrinogen synthesis, these women were compared with 25 women with placental abruption. Hemolysis was assessed indirectly by quantification of reticulocytosis and nucleated red blood cells with determination of erythrocyte morphotypes. RESULTS:: Eighty-percent of women were classified as having unequivocal DIC (mean score 5.9±1.8) at delivery, which persisted 4-5 days postpartum. Fibrinogen regeneration with placental abruption was rapid, whereas it remained depressed for 4-5 days with acute fatty liver of pregnancy; fibrin-fibrinogen split products were also cleared more rapidly after abruption than women with acute fatty liver (P<.001 for interaction for both using random effects modeling). Kaplan-Meier survival analysis of fibrinogen recovery to a set point of 280 mg/dL after delivery was also different between the two cohorts (median 1.7 compared with 4.2 days, P=.046). Continuing hepatic dysfunction with acute fatty liver of pregnancy was exemplified by diminished procoagulant production. Reticulocytosis, nucleated red blood cells, and elevated serum bilirubin levels reflected ongoing hemolysis. CONCLUSIONS:: Hemostatic dysfunction with acute fatty liver of pregnancy persists 4-5 days postpartum and results from substantive ongoing DIC in concert with reduced procoagulant synthesis and clinically significant hemolysis.

AB - OBJECTIVE:: To estimate the frequency of disseminated intravascular coagulation (DIC); elucidate the genesis of hemostatic dysfunction; and characterize associated hemolysis in women with acute fatty liver of pregnancy. METHODS:: Hemostatic function was measured in 51 women. Disseminated intravascular coagulation was assessed using the International Society of Thrombosis and Haemostasis DIC score. Hepatic and hemostatic function was quantified with measurement of fibrinogen, fibrin-fibrinogen split products, cholesterol, and coagulation testing. As a comparison of fibrinogen synthesis, these women were compared with 25 women with placental abruption. Hemolysis was assessed indirectly by quantification of reticulocytosis and nucleated red blood cells with determination of erythrocyte morphotypes. RESULTS:: Eighty-percent of women were classified as having unequivocal DIC (mean score 5.9±1.8) at delivery, which persisted 4-5 days postpartum. Fibrinogen regeneration with placental abruption was rapid, whereas it remained depressed for 4-5 days with acute fatty liver of pregnancy; fibrin-fibrinogen split products were also cleared more rapidly after abruption than women with acute fatty liver (P<.001 for interaction for both using random effects modeling). Kaplan-Meier survival analysis of fibrinogen recovery to a set point of 280 mg/dL after delivery was also different between the two cohorts (median 1.7 compared with 4.2 days, P=.046). Continuing hepatic dysfunction with acute fatty liver of pregnancy was exemplified by diminished procoagulant production. Reticulocytosis, nucleated red blood cells, and elevated serum bilirubin levels reflected ongoing hemolysis. CONCLUSIONS:: Hemostatic dysfunction with acute fatty liver of pregnancy persists 4-5 days postpartum and results from substantive ongoing DIC in concert with reduced procoagulant synthesis and clinically significant hemolysis.

UR - http://www.scopus.com/inward/record.url?scp=84903127418&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84903127418&partnerID=8YFLogxK

U2 - 10.1097/AOG.0000000000000296

DO - 10.1097/AOG.0000000000000296

M3 - Article

VL - 124

SP - 40

EP - 46

JO - Obstetrics and Gynecology

JF - Obstetrics and Gynecology

SN - 0029-7844

IS - 1

ER -