D-dimer test for early detection of HELLP syndrome.

We attempted to predict patients at risk for HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count) by using the D-dimer test to screen 81 preeclamptic gravidas and 12 control subjects. Among preeclamptic patients, 43 had positive and 38 had negative results of D-dimer tests. All controls had negative results. Women with positive results had significantly higher mean arterial pressures at admission and postpartum, lower platelet counts, and elevated liver enzyme values. D-dimer-positive women also had infants with significantly lower birth weight and lower Apgar scores. After delivery, those with a positive D-dimer test were at risk for even greater abnormalities of liver enzymes, as well as lower platelet counts. Abnormalities of any of these laboratory parameters were unlikely in the presence of a negative D-dimer test result (negative predictive value = 0.89). Our results suggest that D-dimer-positive preeclamptic women are at high risk of having HELLP syndrome and should receive close follow-up, whereas D-dimer-negative patients are unlikely to have this disorder and tend to have a better maternal-fetal outcome.