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Reduced Pseudocholinesterase Activity in Patients With HELLP Syndrome

Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel, lurie{at}nashim.net, drslurie{at}hotmail.com, Sackler School of Medicine,Tel Aviv University, Tel Aviv, Israel

Oscar Sadan, MD

Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel, Sackler School of Medicine,Tel Aviv University, Tel Aviv, Israel

Galia Oron, MD

Perinatal Division, Department of Obstetrics and Gynecology, Rabin Medical Center Beilinson Campus, Petah Tiqva, Israel, Sackler School of Medicine,Tel Aviv University, Tel Aviv, Israel

Asora Fux, PhD

Department of Biochemistry, Edith Wolfson Medical Center, Holon, Israel

Mona Boaz, PhD

Epidemiology and Statistics Unit, Edith Wolfson Medcial Center, Holon, Israel, Sackler School of Medicine,Tel Aviv University, Tel Aviv, Israel

Tiberiu Ezri, MD

Department of Anesthesia, Edith Wolfson Medical Center, Holon, Israel, Sackler School of Medicine,Tel Aviv University, Tel Aviv, Israel

Abraham Golan, MD, FRCOG

Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel, Sackler School of Medicine,Tel Aviv University, Tel Aviv, Israel

Jacob Bar, MD

Perinatal Division, Department of Obstetrics and Gynecology, Rabin Medical Center Beilinson Campus, Petah Tiqva, Israel, Sackler School of Medicine,Tel Aviv University, Tel Aviv, Israel

The authors previously reported a case of decreased pseudocholinesterase activity in a patient with HELLP syndrome. It was assumed that the reduced pseudocholinesterase activity in HELLP syndrome is associated with impaired liver function. The present study assesses the prevalence of low pseudocholinesterase in patients with HELLP syndrome. Serum pseudocholinesterase activity was determined with spectrophotometer in 15 patients with HELLP syndrome. Two control groups matched for gestational age were recruited: 15 healthy women with uncomplicated pregnancy and 15 women with severe preeclampsia without HELLP. The prevalence of reduced pseudocholinesterase activity lower than normal limit was 60.0% (9/15) in patients with HELLP syndrome, 33.3% (5/15) in patients with severe preeclampsia, and 6.6% (1/15) in women with normal pregnancy, respectively (P =.009). The pseudocholinesterase activity was found to correlate with serum alanine aminotransferase levels (r = 0.417, P = .006) and with serum aspartate aminotransferase levels (r = 0.462, P = .002). Considering the increased prevalence of reduced pseudocholinesterase activity in patients with HELLP syndrome, the authors suggest that whenever general anesthesia is applied in these patients, the anesthesiologist should be aware that the patient may show slow metabolic degradation of choline-ester drugs.

Key Words: HELLP syndrome • pseudocholinesterase • severe preeclampsia • obstetric anesthesia.

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