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Case Reports
. 2024 Mar 28;11(4):e01317.
doi: 10.14309/crj.0000000000001317. eCollection 2024 Apr.

Severe Elevated Bile Acids in Early Pregnancy

Lucas Fass  1 , Carrie Sibbald  2 , Erin Bailey  2 , Wei Zhang  3 , Michael Lucey  4
Affiliations
Case Reports

Severe Elevated Bile Acids in Early Pregnancy

Lucas Fass et al. ACG Case Rep J. .

Abstract

Intrahepatic cholestasis of pregnancy (ICP) typically presents in the second half of pregnancy. Severe ICP is associated with increased risk of stillbirth. Little is known regarding elevated bile acids in the first trimester. We present a case of severely elevated bile acids in the first trimester, resistant to conservative management, in a patient with pre-existing cholestatic liver disease and aortic valve disease requiring anticoagulation. Therapeutic plasma exchange was used. In those with pre-existing cholestatic disease, early bile acid elevation is likely distinct from ICP, and conservative strategies may not be useful. In addition, therapeutic enoxaparin appears safe in therapeutic plasma exchange.

Keywords: Bile acids; Pregnancy; ductopenia; ntrahepatic cholestasis of pregnancy; vanishing bile duct syndrome.

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Figures

Figure 1.
Figure 1.
Histology of patients severe ductopenia. (A) A normal portal triad (40×). (B) Several portal triads with ductopenia (20×). (C) Magnified triad with no bile duct visualized (40×). BD, bile duct; HA, hepatic artery; HV, hepatic vein.
Figure 2.
Figure 2.
Bile acid trend throughout gestation. TPE, therapeutic plasma exchange.
See this image and copyright information in PMC

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