RELATION BETWEEN GESTATIONAL THROMBOCYTOPENIA AND THE SYNDROME OF HEMOLYSIS, ELEVATED LIVER-ENZYMES, AND LOW PLATELET COUNT (HELLP-SYNDROME)

Objective: To define the clinical features of gestational thrombocytop enia and to determine its relationship to the syndrome of hemolysis, e levated liver enzymes, and low platelet count (HELLP syndrome). Study Design: Retrospective cohort study. We: reviewed the records of 24 wom en with gestational thrombocytopenia among 637 nonpreeclamptic women w ho had serial determinations of the platelet count during pregnancy be tween 1992 and 1995. Gestational thrombocytopenia was defined as an an tenatal gradual decline in the platelet count to <150 x 10(9)/l in non preeclamptic women. The control group consisted of 213 nonpreeclamptic women whose platelet counts were greater than or equal to 150 x 10(9) /l at -3 to 0 days from delivery and in whom the perinatal serum level of aspartate transaminase (AST) had been determined. Results: The pla telet count decreased gradually, from 210 +/- 31 x 10(9)/l at <13 week s' gestation to 127 +/- 24 x 10(9)/l at -3 to 0 days from delivery, in the 24 women with gestational thrombocytopenia. The platelet count wa s 251 +/- 62 x 10(9)/l at -3 to 0 days from delivery in the 213 contro l women. The serum level of AST was elevated perinatally in 5 (21 %) o f 24 women with gestational thrombocytopenia compared with 6 (2.8 %) o f the 213 control subjects (p < 0.001). There had been 28 previous ter m or near-term pregnancies among 17 women with gestational thrombocyto penia, 14 of which were complicated by gestational thrombocytopenia or a decline in the platelet count by > 50 x 10(9)/l; 1 pregnancy was as sociated with the features typical of the HELLP syndrome. Conclusion: Gestational thrombocytopenia may be a risk factor for the development of the HELLP syndrome and is likely to recur in subsequent pregnancies .