[Complications in HELLP syndrome due to peripartal hemostatic disorder]. / Komplikationen beim HELLP-Syndrom infolge einer peripartalen Hämostasestörung.

43 cases with severe preeclampsia with HELLP syndrome were observed out of 14890 deliveries from 1980 to 1993 in the Department of Obstetrics and Gynecology, University of Mainz. In 17 cases there were grave complications (14 renal failure: 3 patients requiring dialysis; 6 bleedings: abdominal wall hematoma in 5 patients after caesarean section, 1 rupture of the liver; 3 pulmonary complications; 9 cerebral complications: 7 eclamptic convulsions, 1 amaurosis caused by partial infarction of the posterior cerebral artery, 1 sinus venous thrombosis). The plasmatic blood-clotting factors were in the normal range, except for 2 cases. In 27 patients TAT and D-dimers were determined. In 17 of these 27 patients TAT and D-dimers increased up to extreme levels (TAT > 20 micrograms/l and D-dimers > 1000 micrograms/l). In 12 of these 17 patients, complications occurred during in the course of the disease (70%). On the other hand, only 3 out of 12 patients (30%) with a low activation of blood coagulation (TAT > 10 and < 20 micrograms/l; D-dimers > 800 and < 1000 microgram(s)/l) had shown complications. It is suggested that the early determination of TAT and D-dimers may help to avoid complications.

[Hepatic failure and disorders of coagulation (author's transl)]. / Leberversagen und Gerinnungsstörungen.

Disorders of coagulation are part of the clinical syndrome in hepatic failure. The pathophysiology of these disorders is discussed; analysis of coagulation defects in hepatic disorders does not help in differential diagnosis of hepatic diseases in the proper sense, but it is of considerable prognostic value. Therapy of hepatic diseases is discussed taking into account the pathophysiology of hepatic disorders; success of any therapeutic approach however is very limited, because of the bad prognosis of the underlying disease.