{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T14:36:25Z","timestamp":1793889385115,"version":"4.8.0"},"reference-count":23,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2022,3,31]],"date-time":"2022-03-31T00:00:00Z","timestamp":1648684800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2022,3,31]],"date-time":"2022-03-31T00:00:00Z","timestamp":1648684800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp; Obste"],"published-print":{"date-parts":[[2022,12]]},"abstract":"Abstract<\/jats:title>\n \n Objective<\/jats:title>\n To describe findings in 8 women initially diagnosed as presumptive HELLP Syndrome, eventually confirmed as TTP\/aHUS as distinguished by elevated calculated LDH:AST ratio\u2009>\u200922:1.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n All medicolegal files of patients evaluated between 1986 and 2015 with presumptive HELLP syndrome but later determined to have TTP\/aHUS had LDH:AST ratios evaluated throughout care.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Fifty\u2010eight pregnant\/postpartum women presented with a diagnosis of presumptive HELLP syndrome. In the final analysis, 8 women had TTP\/aHUS characterized by severe thrombocytopenia (<20\u2009000\/\u03bcl) at admission, rare epigastric pain, and the consistent demonstration of a very high calculated total LDH to AST ratio. This calculation greatly exceeded 22:1 with TTP\/aHUS (mean\u00a0=\u00a032:1) versus 2:1 with HELLP and could be consistently demonstrated throughout care. Six of 8 women with TTP\/aHUS died.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Correctly distinguishing between HELLP syndrome versus an imitator disorder continues to challenge obstetric specialists. This medicolegal data supplements prior findings supporting the concept of the LDH:AST ratio as a useful screening tool for clinicians to differentiate TTP\/aHUS apart from HELLP syndrome in order to facilitate earlier hematology consultation, patient referral to tertiary care and emergent hemotherapy for these mothers.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/ijgo.14177","type":"journal-article","created":{"date-parts":[[2022,3,17]],"date-time":"2022-03-17T22:19:36Z","timestamp":1647555576000},"page":"870-874","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Maternal morbidity and mortality in pregnant\/postpartum women with suspected\n HELLP<\/scp>\n syndrome identifiable as probable thrombotic thrombocytopenic purpura or atypical hemolytic uremic syndrome by high\n LDH<\/scp>\n to\n AST<\/scp>\n ratio"],"prefix":"10.1002","volume":"159","author":[{"suffix":"Jr.","given":"James Nello","family":"Martin","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology The Winfred L. Wiser Hospital for Women & Infants at the University of Mississippi Medical Center Jackson Mississippi USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James Martin","family":"Tucker","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology The Winfred L. Wiser Hospital for Women & Infants at the University of Mississippi Medical Center Jackson Mississippi USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,3,31]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1182\/asheducation-2015.1.644"},{"key":"e_1_2_8_3_1","first-page":"173","volume-title":"Chapter 14 in the 2015 Compendium for HELLP Syndrome: from Bench to Bedside","author":"Morris R","year":"2015"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.preghy.2018.02.007"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tmrv.2018.08.002"},{"issue":"381","key":"e_1_2_8_6_1","first-page":"e1","article-title":"The diagnostic dilemma of thrombotic thrombocytopenic purpura\/hemolytic uremic syndrome in the obstetric triage and emergency department: lessons from 4 tertiary hospitals","volume":"200","author":"Stella CL","year":"2009","journal-title":"Am J Obstet Gynecol"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.preghy.2016.02.001"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2016-216802"},{"key":"e_1_2_8_9_1","first-page":"19","volume-title":"The 2015 Compendium for HELLP Syndrome: from Bench to Bedside (ed Martin JN Jr)","author":"Ankumah NE","year":"2015"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2008.03.011"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.3109\/14767058.2011.619603"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1080\/14767058.2020.1832075"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000215994.25958.31"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1208981"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.00280117"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/1744-9987.12763"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2015.03.017"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mcna.2016.09.010"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2014-02-553131"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/jth.13571"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrdp.2017.20"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.placenta.2012.11.014"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra0902814"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0036-1587683"}],"container-title":["International Journal of Gynecology & Obstetrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ijgo.14177","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ijgo.14177","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ijgo.14177","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T14:07:18Z","timestamp":1793887638000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/ijgo.14177"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,31]]},"references-count":23,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2022,12]]}},"alternative-id":["10.1002\/ijgo.14177"],"URL":"https:\/\/doi.org\/10.1002\/ijgo.14177","archive":["Portico"],"relation":{},"ISSN":["0020-7292","1879-3479"],"issn-type":[{"value":"0020-7292","type":"print"},{"value":"1879-3479","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,31]]},"assertion":[{"value":"2021-05-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-03-09","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-03-31","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}