[Suebee6]

Scary patient today..she was heading south quickly! I have seen labs go bad fast, but not sure if I have seen them go this fast! At 6am Sat am, her platelets were 140,000 AST 45. midnight Sat, AST 145. plts 245,000. 5am Sunday, AST 2580, and plts manual count of 15,000 yikes. Needless to say, she was under general anesthesia shortly thereafter for a section, (29.2 wks gestation). Her pressures 160s /100s even on MAg. And believe it or not, she was really asymptomatic, no headache, not even epigastric pain. And the scariest thing is, when we called our blood bank to get some platelets sent up to transfuse..they didnt have any and tried to tell me it would be 5 hours until they could get them. WHAT?!? Have you heard of such a thing? The anesthesia doc was waiting until we could at least get SOME platelets in her before we cut..but we certainly couldnt wait 5 hours!!! They ended up calling another hospital and shopping, and they sent some over. She did well, so did the baby, and at 2 pm today her AST was 1280 WOOHOO!~!!

[SmilingBluEyes]

wow is all i can say. she is one lucky lady. hopefully babe does ok.

[Suebee6]

yeah..my coworkers kid me it was all my fault for being relief charge today, for some reason me on charge on Sunday always spells some sort of crazy day..

[Mrs.S]

I had a HELLP patient a month or so ago that was scary like that. She was an antepartum pt around 30 weeks about to go home that very day on bedrest and procardia, when she started c/o shortness of breath. Her vitals were fine, sats in the upper 90's, BP's 120's/60's & 70's. they did a CT and coag panel and stuff around 1600 to r/o PE, and her platelets were on the lower end of normal ...115,000-ish. they consulted internal medicine, who had us run an EKG that was abnormal, so they were thinking something cardiac and ordered an echo for the am. Nobody ever ordered liver enzymes & uric acid & stuff. I had her on nights, she was complaining of some back pain (not unusual for antepartum pts who have to sleep on our stiff-as-a-board beds night after night) and was on O2 for her comfort, no headache, visual change, epigastric pain, any of that. she slept for me, baby looked great on continuous EFM, but I just had that god-awful feeling in my gut about her. They drew a repeat CBC along with some other stuff on her at 0630, and just after I had given report to the oncoming RN, lab was calling with a critical value of **26,000** platelets!!

I was off work for a few days after that and just agonized and kicked myself over and over for not thinking to ask one of the docs for PIH labs. it just hadn't occurred to me.

[judyblueeyes]

I really appreciate it when our pih/hellp pts present with the whole clinical picture. The one's who present with only one or two out of whack symptomologies are heck to manage!

[Gompers]

Originally Posted by Suebee6

And the scariest thing is, when we called our blood bank to get some platelets sent up to transfuse..they didnt have any and tried to tell me it would be 5 hours until they could get them. WHAT?!? Have you heard of such a thing? The anesthesia doc was waiting until we could at least get SOME platelets in her before we cut..but we certainly couldnt wait 5 hours!!! They ended up calling another hospital and shopping, and they sent some over.

Yep, we've had this happen, too. However, the longest we've ever had to wait is about 2 hours for a new shipment. When we run out of platelets, Lifesource sends out an on-call person with more units. Platelets are only good for so long and have to be kept in constant motion, plus they usually in short supply so hospitals only get what they are definitely going to use - waste not, want not!

I have a quick question, which I probably should know the answer to because I work in the NICU and take care of a lot of babies born from pre-eclamptic moms. If a mom starts having signs of pre-eclampsia (not HELLP syndrome) does she definitely have to deliver? Or do some improve with medications and get to go home on bedrest?

[Suebee6]

Depends on the severity. We expect them to deliver early so we try to manage with steroids, Mag if needed for pressures..etc. Very close monitoring of proteinurea, (24 hour proteins done) frequent labs for liver function and CBC, of course BPs. Obviously we would rather keep baby inside as long as possible, but when things start to go bad we do what we have to do!

[SmilingBluEyes]

As stated above, depends on severity and lab results. If there is any indication of worsening condition, labor is induced in most cases.

[Gompers]

Originally Posted by SmilingBluEyes

As stated above, depends on severity and lab results. If there is any indication of worsening condition, labor is induced in most cases.

That's what I thought. I was just hoping for another answer.

I have another question. We get a lot of babies from pre-eclamptic moms, as I stated before. The moms are usually on mag for 24 hours post delivery, and during this time they cannot come up to the NICU and visit. Is this because they need continuous monitoring or because they cannot sit up in a wheelchair? We've only had one or two come up in emergency situations and they're brought up on a gurnee. I'm just wondering about it because I don't remember learning too much about mag when I was in my OB rotation.

[Suebee6]

I can't answer that one, because we bring our moms over ASAP to see the babies. Our NICU is across the hall...so it is very easy to go over. (well easy as can be with multiple IVACs and IV poles and IV lines ..etc LOL) Even my very sick mom from above was allowed time with her baby. The moms are very unstable...maybe that is why? But seeing her baby helps.. IMO...