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Saved by the Massive Transfusion Protocol: A Case Report of an Obstetric Patient With Hemolysis, Elevated Liver Enzymes, and Low Platelet Count (HELLP) Syndrome and Glisson Capsule Rupture

Horazeck, Christian MD*; Crockett, Christy J. MD

doi: 10.1213/XAA.0000000000000949
Case Reports

A 31-year-old primigravid parturient with no pertinent medical history was admitted at 40 weeks and 4 days of gestation for postdate induction of labor. She was subsequently diagnosed with preeclampsia and developed hemolysis, elevated liver enzymes, and a low platelet count. An emergency cesarean delivery ensued owing to fetal bradycardia. Massive hemorrhage occurred on incision, and a diagnosis of ruptured subcapsular hepatic hematoma was made. The hemorrhage was managed using our institution’s massive transfusion protocol. Early transfusions and mobilization of necessary support stipulated in this protocol led to full recovery of the patient, with no significant morbidity.

From the *Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina

Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee.

Accepted for publication November 13, 2018.

Funding: None.

The authors declare no conflicts of interest.

Address correspondence to Christian Horazeck, MD, Department of Anesthesiology, Duke University Medical Center, 3 Monaco Ct, Durham, NC 27713. Address e-mail to

Copyright © 2018 International Anesthesia Research Society
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