Straight to HELLP

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atvlady
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Re : Straight to HELLP

Postby atvlady » Fri May 21, 2010 08:57 pm

tree.....what happened to you is so very close to what happened to me. I had a official diagnosis of HELLP before pre-e. Weird.

tree
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Re : Straight to HELLP

Postby tree » Fri May 21, 2010 05:54 pm

Caryn's descriptions sounds a lot like what happened to me. I was heading towards pre-E (125/80 was 30/15 high for me), but I was diagnosed with HELLP first. Technically, I did go "straight to HELLP" because the blood work came back before anyone had a chance to test for protein. My blood pressure was also up to 135/85 by that time. I don't think I would have started down the path to HELLP unless my body was already suffering some impacts from impending pre-E. My diagnosis was officially "severe pre-E and HELLP" even though I didn't meet the official diagnostic limits for pre-E.

atvlady
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Re : Straight to HELLP

Postby atvlady » Fri May 21, 2010 05:35 pm

Thanks Caryn...VERY interesting! My pre-e was slowly creeping up on me but at week 12 I had a 30 point jump in my BP. At week 16 I had the horrible swelling. At week 18 I had the URQ slowly coming on. Delivering at 20 weeks (most of you know this). My placenta autopsy showed infract meaning some of the placenta had come off the uterine wall.
Me dealing with AIHA have learned a lot about the Hemolysis that goes along with this. I am kinda excited to get pregnant again to see what happens now that my AIHA is almost under control.
Also, I saw my Cardiologist in passing and told him what happened and he told me to take Magnesium Oxide, 800mg twice daily. Is there any truth behind this?

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caryn
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Re : Straight to HELLP

Postby caryn » Fri May 21, 2010 12:35 am

The researchers are thinking that they know what's going on here -- kinda. :)

There are two known soluble factors produced by the placenta that contribute to symptoms. (It produces more soluble factors than just these two, but these are the ones that seem to trigger symptoms.) They're called soluble fms-like tyrosine kinase (shortened to sFLT-1 or soluble FLT) and soluble endoglin (shortened to sEng.)

In PE we have more soluble FLT than sEng -- to make up some imaginary values, let's say it's 300 mg of soluble FLT and 100 mg of sEng -- and in HELLP it's the other way around.

But it also seems like once you hit some absolute value of soluble FLT, you'll have PE symptoms.

So as I understand it, women who develop HELLP but not PE hit the threshold value for sEng, but not the threshold value for soluble FLT that would make them develop PE too. Women who develop PE but not HELLP have enough soluble FLT to trigger PE symptoms, but not enough sEng to trigger HELLP symptoms. And women with PE and superimposed HELLP hit the soluble FLT threshold, then continue to worsen and tip over the sEng threshold as well.

It really depends a lot on how that particular placenta is triggering these chemical cascades, then, and which dominoes fall over first.

I'm never quite sure I buy the idea that you can have HELLP without PE, though. That's because for hemolysis to occur, there has to be really, really severe vasoconstriction in the capillaries. And once someone crashes into HELLP you're not going to run a 24-hour, so we don't ever really have quantitative data on proteinuria at the time that HELLP patients are really sick, though docs will often run those tests while they're in recovery. At that point, though, the proteinuria could already have begun to regress if they have kidneys of steel. (Am thinking here of the posters who limp along for months with spectacular hypertension but no proteinuria.)

I'm inclined to guess that women who present with HELLP first just tip into illness so incredibly rapidly that while they've got severe hypertension manifesting in the capillaries, they've also got so much sEng interfering with their normal processes that no one has time or incentive to document their borderline PE. If that makes sense.

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Re : Straight to HELLP

Postby dohertyab » Fri May 21, 2010 08:53 am

I went straight to HELLP. No pre-e. I was fine in the dr office in the morning having a glucose test and then 18 hours later BP was 160/110 and protein off the scale, med evac'd and later determined HELLP. I was 28 weeks when it happened. They did stabilize me for 5 days before the twins were born but liver and kidney shut down a second time, so we delivered. No underlying conditions, the drs just said it was sudden onset most likely due to twins. I was 32 and very healthy, good weight, no history but I did have twins. Don't know if this helps.

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Re : Straight to HELLP

Postby beiram » Fri May 21, 2010 08:18 am

That would be me. I went straight to HELLP and also had a placental abruption. No PE before or after delivery. I was only 25 weeks pregnant.

I don't know why some women can go straight to HELLP. The doctor who performed by emergency c-section told me that "it just happens". I was checked for autoimmune disorders two years after the delivery and everything came back normal. He said that my case is very unusual because I was in my mid-twenties, very healthy, and with no history of PE in my family. So I still don't have an explanation for why this happened to me. As he stated: "I had bad luck".

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Straight to HELLP

Postby atvlady » Mon May 17, 2010 08:47 pm

Has anyone went straight to HELLP with no or after delivery with Pre-e?

Does anyone know why some women can go straight to HELLP?



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