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Case Reports
. 2022 Apr 1;14(4):e23724.
doi: 10.7759/cureus.23724. eCollection 2022 Apr.

Hepatic Infarction in a Patient With Sickle Cell Trait Presenting With HELLP Syndrome

Anish C Paudel  1 , John F Altomare  2 , Oluwaseun Shogbesan  2 , Andrew Lee  2 , Parth Desai  2 , Jesus S Noain  2 , Suravi Khanal  3
Affiliations
Case Reports

Hepatic Infarction in a Patient With Sickle Cell Trait Presenting With HELLP Syndrome

Anish C Paudel et al. Cureus. .

Abstract

Hepatic infarction is uncommon due to the dual blood supply from the hepatic artery and portal vein. The majority of the cases are caused following liver transplant or hepatobiliary surgery, hepatic artery occlusion, or shock. Hepatic infarction is a rare complication of hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome. HELLP is an obstetrical emergency requiring prompt delivery. The presence of elevated liver enzymes, mainly alanine aminotransferase and aspartate aminotransferase in pre-eclampsia, should warrant diagnosis and treatment in the line of HELLP syndrome. Our patient with underlying sickle cell trait presented with features of HELLP syndrome in her third trimester of pregnancy. She underwent cesarean delivery on the same day of the presentation. The liver enzymes continued to rise following delivery and peaked on postoperative day two. Contrast computed tomography scan showed multifocal hepatic infarctions. Pre-eclampsia by itself is a state of impaired oxygenation and can lead to hepatic hypoperfusion, and appeared to be a clear contributor to the hepatic infarction in this case. However, this case also raises the question of whether the underlying sickle cell trait might have potentiated the hepatic infarction. Although sickle cell disease is well known to cause hepatic infarctions, it is unknown whether the sickle cell trait affects the liver to a similar extent as sickle cell disease. In addition, there have been case reports of sickle cell trait causing splenic infarcts and renal papillary necrosis, but it remains unclear if it can be directly associated with hepatic infarction.

Keywords: elevated liver enzymes; hellp syndrome; hepatic infarction; preeclampsia; sickle cell trait.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Enzyme levels during hospitalization.
AST: aspartate aminotransferase; ALT: alanine aminotransferase; LDH: lactate dehydrogenase
Figure 2
Figure 2. Contrast CT of the abdomen showing areas of hepatic infarction.
CT: computed tomography
See this image and copyright information in PMC

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