hellp syndrome grey
TRANSCRIPT
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BAB I
TINJAUAN PUSTAKA
HELLP SYNDROME
1. DEFINISI
Sindrom HELLP (hemolysis, elevated liver enzyme, and low platelet )
adaa! "#$a%a&dar'ra&an o&ri" dimana r*adi +r##"am+ia,#"am+ia -an$
di#r&ai &im'n-a !#moii ($amar 1) +#nin$"a&an #n/im !#+ar di0'n$i
!#+ar dan &romoi&o+#nia.12
Gambar 1. Hemolisis eritrosit 3
. EPIDEMIOLO4I
Sindrom HELLP dim'"an +ada 516 7 589 : "#!amian dan #i!
#rin$ dim'"an +ada m'&i+ara &'a %ani&a ra Ka'"aian. Pada 65: "a'
indrom HELLP didia$noi aa& an+ar&'m; 15: ##'m 6 min$$' 65:
an&ara 'ia "#!amian 6 7 26 min$$' dan 5: #a! 26 min$$'. Pada 25:
"a' rdia$noi +ada aa& in&ra
Sindrom HELLP r*adi +ada 1 7 8 +#r 1555 "#!amian. Pada "#!amian
d#n$an +r#
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Da&a ain -an$ #r!''n$an d#n$an on#& m'n?'n-a indrom HELLP
dia*i"an daam &a# #ri"'&.3
Ta# 1. On#& "#m'n?'an indrom HELLP3
Hubungannya dengan kelahiran Persentasi
An+ar&'m
Po&+ar&'m
@38 *am
38 *am
6
8
85
5
Hubungannya dengan usia kehamilan Persentasi
16 7 5
1 7 6
8 7 2>26
15
>85
#rdaar"an +ada 255 "a'
2. KLASIFIKASI
Kai0i"ai indrom HELLP m#n'r'& Miii+i (#rdaar"an "adar
&romoi& dara!) -ai&' #a$ai #ri"'&.16
< K#a 1
Kadar &romoi& @ 95.555,m
LDH C >55 IU,
AST dan,a&a' ALT C 35 IU,< K#a
Kadar &romoi& 95.555 @ 155.555,m
LDH C >55 IU,
AST dan,a&a' ALT C 35 IU,
< K#a 2
Kadar &romoi& 155.555 @ 195.555,m
LDH C >55 IU,
AST dan,a&a' ALT C 35 IU,
S#dan$ "ai0i"ai #rdaar"an T#n## -ai&' #a$ai #ri"'&.6
< Kom+i&
Kadar &romoi& 155.555,m
LDH C >55 IU,
AST dan,a&a' ALT C 35 IU,
< In"om+i&
Pr##"am+ia #ra& -an$ di#r&ai aa! a&'; ELLP HEL EL a&a' LP.
3. FAKTOR RISIKO
T#rda+a& an-a" 0a"&or r#i"o 'n&'" r*adin-a !i+#rni daam
"#!amian -an$ da+a& di"#om+o""an daam 0a"&or r#i"o #ri"'&;1
2
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- Primi$raida.
- Hi+#r+a#n&oi mian-a ; moa !ida&idoa "#!amian m'&i+# dia#
m#i&' a-i #ar.
- Um'r -an$ #"&rim (29 &a!'n).
- Ri%a-a& "#'ar$a +#rna! +r##"amia,#"amia.
- P#n-a"i&
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Gambar 2. Invasi trofoblas ke arteri spiralis8
. T#ori i"#mi" +a#n&a radi"a #a dan di0'n$i #ndoI"#mi" +a#n&a r*adi a"ia& "#$a$aan r#mod#in$ arri +irai.
ao"on&ri"i +#m''! dara! m#n-#a"an +#n'r'nan airan dara!
'ro+a#n&a #!in$$a r*adi i"#mia.1
S#?ara norma daam &''! rda+a& +rod'"i radi"a #a a&a'
o"idan -an$ diiman$i d#n$an +rod'"i an&i
-ai&' +rod'"i +ro&a$andin -ai&' m#n'r'nn-a +rod'"i +ro&ai"in
(P4E) -an$ m#r'+a"an aodia&or "'a&
- A$r#$ai &romoi& -an$ m#m+rod'"i &romo"an (TGA) -an$
m#r'+a"an ao"on&ri"&or "'a&- P#r'a!an "!a # #ndo "a+i#r $om#r'' ($om#r'ar
#ndo&!#ioi)
- P#nin$"a&an +#rm#aii&a "a+i#r
- P#nin$"a&an +rod'"i a!an
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#!in$$a !ai "on#+i &ida" di&oa". HLA
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>. MANIFESTASI KLINIS
4#*aa -an$ da+a& di"#'!"an +ai#n +ada #"i&ar 9: +ai#n #"am+ia
dari >1 +ai#n d#n$an indrom HELLP #r!''n$an d#n$an n-#ri "#+aa m'a
dan m'n&a! $an$$'an +#n$i!a&an dan n-#ri #+i$a&ri". Pada ##ra+a "a'
da+a& dim'"an adan-a +#rdara!an +on&an a&a' +#rdara!an
$a&roin&ina.39
Gambar 2. !tiopatogenesis preeklampsia=Pada +#m#ri"aan 0ii" da+a& dim'"an &anda #+#r&i n-#ri "an
"'adran "anan a&a +#nama!an #ra& adan -an$ i$ni0i"an #d#ma
$#n#raia&a +#nin$"a&an "anan dara! -an$ #ra& dan i"r'.39
B#ri"'& a"an di*aar"an m#n$#nai "ondii -an$ m#n'n*'""an $amaran
"ini dari main$
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+#n$i!a&an
PRES
Aaio r#&ina
4S 12
S&ro"# TIA a&a' RIND
Kardior#+irai
N-#ri dada,#a"
na+a
Sa&'rai O =6:
Hi+#rni #ra& -an$ &ida"
r"on&ro (daam +#riod# 1
*am d#n$an +#n$$'naan 2 a$#n
an&i
Sa&'rai =5: m#m#r'"an
ra+i O C95: 1 *am
in&'ai 'n&'" +ai#n STP
#d#ma +ar' i"#mi"
m-o"ardi'm a&a' in0ar".
H#ma&oo$i
P#nin$"a&an #'"oi&
P#nin$"a&an PTT
Tromoi&o+#nia
J'ma! +a#& 95 152,L
Di'&'!"an &ran0'i
4in*a
P#nin$"a&an "adar
'r#'m
P#nin$"a&an "adar
"r#a&inin
4an$$'an $in*a a"'&
("r#a&inin 195 M
&an+a $an$$'an $in*a##'m-a) indi"ai 'n&'"
diaii
H#+ar
M'a a&a' m'n&a!
n-#ri "'andran "anan
a&a a&a' #+i$a&ri"
P#nin$"a&an #r'm
S4OT S4PT LDH
a&a' iir'in
Kadar a'min +ama
r#nda!
Di0'n$i !a&i
R'+&'r a&a' !#ma&om !#+ar
F#&o
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6. DIA4NOSIS
Dia$noi indrom HELLP da+a& di$a""an #rdaar"an anamn#i
+#m#ri"aan 0ii" dan +#m#ri"aan +#n'n*an$ -an$ m#nd'"'n$ "!''n-a
+#m#ri"aan aora&ori'm.1239=
a. P#m#ri"aan Laora&ori'm
Dia$noi dini indrom HELLP #rdaar"an !#moii 0'n$i !a&i dan
di0'n$i $in*a.
Hemolisis da+a& di'"&i"an d#n$an +#nin$"a&an "adar lactatedehydrogenase '(&H) >55 IU,L dan +#n'r'nan "adar #r'm !a+&o$o'in.
Mar"#r #ni&i0 ini da+a& did#"i ##'m r*adi +#nin$"a&an #r'm iir'in
indir#" dan +#n'r'nan "adar !#mo$oin.9
Peningkatan enzim hati (S4OT dan S4PT) m#r'+a"an mar"#r a%a adan-a
!#moii dan "#r'a"an !#+ar. *rothrombin time (PT) dan activated partial
thromboplastin time (APTT) ia a*a norma +ada a%a +#r*aanan +#n-a"i&
nam'n "adar +rod'" d#$radai 0irin D
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Bia *'ma! &romoi& m#n'r'n 95.555,mm2 -an$ di!''n$"an d#n$an DI
d#n$an +ro$noi 'r'".9
P#n'r'nan *'ma! &romoi& marna r*adi #$#ra #a! +ro# "#a!iran
"#m'dian m'ai m#nin$"a& 2 !ari +o& *am +o&<
+ar&'m m#r'+a"an indi"ai "#ainan -an$ #ra& d#n$an "#m'n$"inan
+#r"#man$an $a$a m'&i
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+ada im'no0'or##n +ada ## in'oid !#+ar. S+#im#n !#+ar
m#n'n*'""an !ai +oi&i0 +ada r#a"i r!ada+ IL "ai,m#ni&
ara +#m#rian M$SO31
Doi a%a;
- Ami 3 $ ar'&an M$SO3 (15 m ar'&an M$SO3 35:) dan ar'&"an
d#n$an 15 m a"'ad#.
- Bo' +#ra!an #?ara I #ama 15
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- Ji"a a"# I 'i& #ri"an main$ $ ar'&an M$SO3 (19 m$ ar'&an M$SO3 35:) dan ar'&"an daam
ringer lactate a&a' ringer acetate a' #ri"an #?ara I d#n$an "#?#+a&an
8 +#r m#ni& #ama > *am dan di'an$ !in$$a 3 *am #a!
+#rainan a&a' #a! "#*an$ #ra"!ir (ia #"am+ia).
La"'"an +#m#ri"aan 0ii" &ia+ *am m#i+'&i "anan dara! r#"'#ni
nadi 0r#"'#ni +#rna+aan r#"#"0 +aa dan *'ma! 'rin. Bia 0r#"'#ni
+#rna+aan 1>,m#ni& dan,a&a' &ida" dida+a&"an r#0#" ndon +aa
dan,a&a' rda+a& oi$o'ria (+rod'"i 'rin 59 m,"$BB) #$#ra !#n&i"an
+#m#rian M$SO3. Bia r*adi d#+r#i na+a #ri"an "ai'm $'"ona 1 $
I (15 m ar'&an 15:) o' daam 15 m#ni&. Bia "#*an$ #r'an$ #ri"an
M$SO3 $ I +#ra!an (15
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Ind'"i +#rainan m#r'+a"an ra+i +#i0i" +ada indrom HELLP. Pada
i' d#n$an 'ia "#!amian C23 min$$' dir#"om#ndai"an 'n&'" ind'"i
##$#ra m'n$"in. Kom+i"ai m#m#ra& "#&i"a ind'"i +#rainan r&'nda
#i! dari 1 *am. Pada i' d#n$an 'ia "#!amian an&ara 3
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Dia# ini+id' n#0ro$#ni" *aran$ r*adi -an$ di"ara"ri&i""an
d#n$an r#ini ar$inin5: m#n*adi
"#ma&ian *anin daam ra!im (KJDR) 25: +#r&'m'!an *anin r!ama&
(PJT) dan 9: &romoi&o+#nia. Maa "ri&i #r"#man$ #a! ind'"i
+#rainan. Pada "#!amian #an*'&n-a da+a& #r'an$ 32:.9
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