{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T17:55:39Z","timestamp":1792691739736,"version":"4.5.0"},"reference-count":75,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2024,2,6]],"date-time":"2024-02-06T00:00:00Z","timestamp":1707177600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Thrombotic microangiopathies (TMAs) comprise a distinct group of diseases with different manifestations that can occur in both pediatric and adult patients. They can be hereditary or acquired, with subtle onset or a rapidly progressive course, and they are particularly known for their morbidity and mortality. Pregnancy is a high-risk time for the development of several types of thrombotic microangiopathies. The three major syndromes are hemolysis, elevated liver function tests, and low platelets (HELLP); hemolytic uremic syndrome (HUS); and thrombotic thrombocytopenic purpura (TTP). Because of their rarity, clinical information and therapeutic results related to these conditions are often obtained from case reports, small series, registries, and reviews. The collection of individual observations, the evolution of diagnostic laboratories that have identified autoimmune and\/or genetic abnormalities using von Willebrand factor post-secretion processing or genetic\u2013functional alterations in the regulation of alternative complement pathways in some of these TMAs, and, most importantly, the introduction of advanced treatments, have enabled the preservation of affected organs and improved survival rates. Although TMAs may show different etiopathogenesis routes, they all show the presence of pathological lesions, which are characterized by endothelial damage and the formation of thrombi rich in platelets at the microvascular level, as a common denominator, and thrombotic damage to microcirculation pathways induces \u201cmechanical\u201d (microangiopathic) hemolytic anemia, the consumption of platelets, and ischemic organ damage. In this review, we highlight the current knowledge about the diagnosis and management of these complications during pregnancy.<\/jats:p>","DOI":"10.3390\/diagnostics14040352","type":"journal-article","created":{"date-parts":[[2024,2,6]],"date-time":"2024-02-06T05:36:43Z","timestamp":1707197803000},"page":"352","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["HELLP Syndrome and Differential Diagnosis with Other Thrombotic Microangiopathies in Pregnancy"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9427-1391","authenticated-orcid":false,"given":"Stefano Raffaele","family":"Giannubilo","sequence":"first","affiliation":[{"name":"Department of Clinical Sciences, Polytechnic University of Marche, Via Corridoni 11, 60123 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2267-0270","authenticated-orcid":false,"given":"Daniela","family":"Marzioni","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Via Tronto 10\/a, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7003-1230","authenticated-orcid":false,"given":"Giovanni","family":"Tossetta","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Via Tronto 10\/a, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Ciavattini","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Polytechnic University of Marche, Via Corridoni 11, 60123 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,2,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1016\/j.emc.2014.04.008","article-title":"Thrombotic microangiopathies (TTP, HUS, HELLP)","volume":"32","author":"Kappler","year":"2014","journal-title":"Emerg. Med. Clin. N. Am."},{"key":"ref_2","first-page":"166","article-title":"Thrombotic microangiopathy: Differential diagnosis, pathophysiology and therapeutic strategies","volume":"72","author":"Mayer","year":"2005","journal-title":"Mt. Sinai. J. Med."},{"key":"ref_3","first-page":"662","article-title":"The long-term consequences of thrombotic microangiopathy (thrombotic thrombocytopenic purpura and hemolytic uremic syndrome) in pregnancy","volume":"91","author":"Dashe","year":"1998","journal-title":"Obstet. Gynecol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"999","DOI":"10.1016\/S0140-6736(15)00070-7","article-title":"Pre-eclampsia","volume":"387","author":"Mol","year":"2016","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/S0002-9378(16)32330-4","article-title":"Syndrome of hemolysis, elevated liver enzymes, and low platelet count: A severe consequence of hypertension in pregnancy","volume":"142","author":"Weinstein","year":"1982","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1111\/j.1471-0528.1997.tb14346.x","article-title":"The HELLP syndrome","volume":"104","author":"Geary","year":"1997","journal-title":"Br. J. Obstet. Gynaecol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2101","DOI":"10.1111\/j.1523-1755.2005.00316.x","article-title":"Preeclampsia: A renal perspective","volume":"67","author":"Karumanchi","year":"2005","journal-title":"Kidney Int."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1097\/GRF.0000000000000253","article-title":"Diagnosis and Management of HELLP Syndrome Complicated by Liver Hematoma","volume":"60","author":"Ditisheim","year":"2017","journal-title":"Clin. Obstet. Gynecol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1000","DOI":"10.1016\/0002-9378(93)90043-I","article-title":"Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome)","volume":"169","author":"Sibai","year":"1993","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"236.e1","DOI":"10.1016\/j.ajog.2011.04.022","article-title":"Placental expression of endothelial and inducible nitric oxide synthase and nitric oxide levels in patients with HELLP syndrome","volume":"205","author":"Mazzanti","year":"2011","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1016\/j.biopha.2018.10.082","article-title":"Preeclampsia: A close look at renal dysfunction","volume":"109","author":"Sani","year":"2019","journal-title":"Biomed. Pharmacother."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1080\/14767058.2016.1189897","article-title":"Disseminated intravascular coagulation in the HELLP syndrome: How much do we really know?","volume":"30","author":"Haram","year":"2017","journal-title":"J. Matern. Fetal. Neonatal. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/j.ejogrb.2004.01.044","article-title":"Adverse pregnancy outcomes are associated with multiple maternal thrombophilic factors","volume":"117","author":"Tranquilli","year":"2004","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1080\/14767050500380976","article-title":"Is there a diurnal pattern in the clinical symptoms of HELLP syndrome?","volume":"19","author":"Koenen","year":"2006","journal-title":"J. Matern. Fetal Neonatal. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1016\/0002-9378(90)90376-I","article-title":"The HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets): Much ado about nothing?","volume":"162","author":"Sibai","year":"1990","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1097\/01.ogx.0000146948.19308.c5","article-title":"HELLP syndrome: The state of the art","volume":"59","author":"Baxter","year":"2004","journal-title":"Obstet. Gynecol. Surv."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1515\/JPM.2000.033","article-title":"HELLP syndrome","volume":"28","author":"Rath","year":"2000","journal-title":"J. Perinat. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.preghy.2019.11.012","article-title":"The role of hepatic sinusoidal obstruction in the pathogenesis of the hepatic involvement in HELLP syndrome: Exploring the literature","volume":"19","author":"Bekkers","year":"2020","journal-title":"Pregnancy Hypertens."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1016\/j.ajog.2005.08.044","article-title":"Understanding and managing HELLP syndrome: The integral role of aggressive glucocorticoids for mother and child","volume":"195","author":"Martin","year":"2006","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"21","DOI":"10.2147\/JBM.S273047","article-title":"DIC in Pregnancy\u2014Pathophysiology, Clinical Characteristics, Diagnostic Scores, and Treatments","volume":"13","author":"Erez","year":"2022","journal-title":"J. Blood Med."},{"key":"ref_21","first-page":"97","article-title":"Disseminated intravascular coagulation and the syndrome of hemolysis, elevated liver enzymes, and low platelets in severe preeclampsia","volume":"73","author":"Renier","year":"1989","journal-title":"Obstet. Gynecol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1111\/ajo.13318","article-title":"Managing a rare complication of HELLP syndrome in Australia: Spontaneous liver haematoma in pregnancy","volume":"61","author":"Gupta","year":"2021","journal-title":"Aust. N. Z. J. Obstet. Gynaecol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1159\/000082648","article-title":"Perinatal outcomes in severe preeclampsia-eclampsia with and without HELLP syndrome","volume":"59","author":"Gul","year":"2005","journal-title":"Gynecol. Obstet. Investig."},{"key":"ref_24","first-page":"481","article-title":"Comparison between HELLP syndrome, chronic hypertension, and superimposed preeclampsia on chronic hypertension without HELLP syndrome","volume":"32","author":"Zengin","year":"2004","journal-title":"J. Perinat. Med."},{"key":"ref_25","first-page":"419","article-title":"HELLP syndrome\u2014A multisystemic disorder","volume":"16","author":"Mihu","year":"2007","journal-title":"J. Gastrointestin. Liver. Dis."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1111\/j.1440-1754.2004.00311.x","article-title":"Maternal haemolysis, elevated liver enzymes and low platelets syndrome: Perinatal and neurodevelopmental neonatal outcomes for infants weighing less than 1250 g","volume":"40","author":"Singhal","year":"2004","journal-title":"J. Paediatr. Child Health"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1007\/s00404-012-2371-x","article-title":"Nifedipine versus labetalol in the treatment of hypertensive disorders of pregnancy","volume":"286","author":"Giannubilo","year":"2012","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1097\/AOG.0000000000000140","article-title":"Risk factors, management, and outcomes of hemolysis, elevated liver enzymes, and low platelets syndrome and elevated liver enzymes, low platelets syndrome","volume":"123","author":"Fitzpatrick","year":"2014","journal-title":"Obstet. Gynecol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1016\/S1246-7820(01)00129-X","article-title":"Platelet transfusion trigger in difficult patients","volume":"8","author":"Rebulla","year":"2001","journal-title":"Transfus. Clin. Biol."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies (2006). Practice guidelines for perioperative blood transfusion and adjuvant therapies: An updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. Anesthesiology, 105, 198\u2013208.","DOI":"10.1097\/00000542-200607000-00030"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"(2016). Practice Guidelines for Obstetric Anesthesia: An Updated Report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia and the Society for Obstetric Anesthesia and Perinatology. Anesthesiology, 124, 270\u2013300.","DOI":"10.1097\/ALN.0000000000000935"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1111\/j.1365-2141.2009.07899.x","article-title":"The risk of spinal haematoma following neuraxial anaesthesia or lumbar puncture in thrombocytopenic individuals","volume":"148","author":"Nokes","year":"2010","journal-title":"Br. J. Haematol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1081\/PRG-100100137","article-title":"Maternal outcome following temporizing management of the (H)ELLP syndrome","volume":"19","author":"Wolf","year":"2000","journal-title":"Hypertens. Pregnancy"},{"key":"ref_34","first-page":"53","article-title":"Prolongation of premature gestation in women with hemolysis, elevated liver enzymes and low platelets. A report of five cases","volume":"35","author":"Heyborne","year":"1990","journal-title":"J. Reprod. Med."},{"key":"ref_35","first-page":"743","article-title":"High-order multiple pregnancies complicated by HELLP syndrome. A report of four cases with corticosteroid therapy to prolong gestation","volume":"42","author":"Heller","year":"1997","journal-title":"J. Reprod. Med."},{"key":"ref_36","first-page":"751","article-title":"Preeclampsia associated with hemolysis, elevated liver enzymes, and low platelets\u2014An obstetric emergency?","volume":"62","author":"MacKenna","year":"1983","journal-title":"Obstet. Gynecol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1111\/j.1471-0528.1995.tb09062.x","article-title":"Temporising management of severe pre-eclampsia with and without the HELLP syndrome","volume":"102","author":"Visser","year":"1995","journal-title":"Br. J. Obstet. Gynaecol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1067\/mob.2002.121074","article-title":"Maternal benefit of corticosteroid therapy in patients with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome: Impact on the rate of regional anesthesia","volume":"186","author":"Shumate","year":"2002","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.1016\/S0002-9378(97)70005-X","article-title":"Better maternal outcomes are achieved with dexamethasone therapy for postpartum HELLP (hemolysis, elevated liver enzymes, and thrombocytopenia) syndrome","volume":"177","author":"Martin","year":"1997","journal-title":"Am. J Obstet. Gynecol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/S0020-7292(98)00036-8","article-title":"Effects of postpartum corticosteroids in patients with HELLP syndrome","volume":"61","author":"Yalcin","year":"1998","journal-title":"Int. J. Gynaecol. Obstet."},{"key":"ref_41","first-page":"CD003106","article-title":"Interventionist versus expectant care for severe pre-eclampsia between 24 and 34 weeks\u2019 gestation","volume":"10","author":"Churchill","year":"2018","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1067\/mob.2002.120279","article-title":"Acute renal failure complicating severe preeclampsia requiring admission to an obstetric intensive care unit","volume":"186","author":"Drakeley","year":"2002","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_43","unstructured":"Society of Obstetric Medicine of Australia and New Zeland (2008). Guidelines for the Management of Hypertensive Disorders of Pregnancy, Society of Obstetric Medicine of Australia and New Zeland."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1097\/OGX.0000000000000126","article-title":"Preeclampsia: What could happen in a subsequent pregnancy?","volume":"69","author":"Giannubilo","year":"2014","journal-title":"Obstet. Gynecol. Surv."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"918","DOI":"10.1016\/j.ahj.2008.06.042","article-title":"Cardiovascular sequelae of preeclampsia\/eclampsia: A systematic review and meta-analyses","volume":"156","author":"McDonald","year":"2008","journal-title":"Am. Heart J."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1097\/AOG.0000000000003554","article-title":"Pregnancy-Associated Atypical Hemolytic Uremic Syndrome: A Systematic Review","volume":"135","author":"Gupta","year":"2020","journal-title":"Obstet. Gynecol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"2847","DOI":"10.1182\/blood-2016-11-709865","article-title":"HUS and atypical HUS","volume":"129","author":"Jokiranta","year":"2017","journal-title":"Blood"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"2163","DOI":"10.1007\/s00467-016-3420-7","article-title":"Fecal diagnostics in combination with serology: Best test to establish STEC-HUS","volume":"31","author":"Wijnsma","year":"2016","journal-title":"Pediatr. Nephrol."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Jamme, M., Raimbourg, Q., Chauveau, D., Seguin, A., Presne, C., Perez, P., Gobert, P., Wynckel, A., Prov\u00f4t, F., and Delmas, Y. (2017). Predictive features of chronic kidney disease in atypical haemolytic uremic syndrome. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0177894"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1053\/j.ajkd.2015.12.034","article-title":"Terminal Complement Inhibitor Eculizumab in Adult Patients With Atypical Hemolytic Uremic Syndrome: A Single-Arm, Open-Label Trial","volume":"68","author":"Fakhouri","year":"2016","journal-title":"Am. J. Kidney Dis."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"554","DOI":"10.2215\/CJN.04760512","article-title":"Genetics and outcome of atypical hemolytic uremic syndrome: A nationwide French series comparing children and adults","volume":"8","author":"Fakhouri","year":"2013","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1053\/j.seminhematol.2018.04.009","article-title":"Anticomplement Treatment in Atypical and Typical Hemolytic Uremic Syndrome","volume":"55","author":"Fakhouri","year":"2018","journal-title":"Semin. Hematol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1237","DOI":"10.2215\/CJN.00280117","article-title":"Hemolytic Uremic Syndrome in Pregnancy and Postpartum","volume":"12","author":"Bruel","year":"2017","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1111\/nep.12935","article-title":"Suspected atypical haemolytic uraemic syndrome in two post-partum patients with foetal-death in utero responding to eculizumab","volume":"22","author":"Chua","year":"2017","journal-title":"Nephrology"},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Sarno, L., Conca, P., Capuano, A., Tarantino, G., Russo, D., and Guida, M. (2022). A Life-Threating Postpartum Atypical Hemolytic-Uremic Syndrome with Multiorgan Involvement. J. Clin. Med., 11.","DOI":"10.3390\/jcm11236957"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1007\/s40620-016-0357-7","article-title":"Atypical hemolytic uremic syndrome in the setting of complement-amplifying conditions: Case reports and a review of the evidence for treatment with eculizumab","volume":"30","author":"Asif","year":"2017","journal-title":"J. Nephrol."},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Sukumar, S., L\u00e4mmle, B., and Cataland, S.R. (2021). Thrombotic Thrombocytopenic Purpura: Pathophysiology, Diagnosis, and Management. J. Clin. Med., 10.","DOI":"10.3390\/jcm10030536"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"2103","DOI":"10.1182\/blood.2020005221","article-title":"Management of thrombotic microangiopathy in pregnancy and postpartum: Report from an international working group","volume":"136","author":"Fakhouri","year":"2020","journal-title":"Blood"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1111\/jth.13571","article-title":"Consensus on the standardization of terminology in thrombotic thrombocytopenic purpura and related thrombotic microangiopathies","volume":"15","author":"Scully","year":"2017","journal-title":"J. Thromb. Haemost."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"2107","DOI":"10.3324\/haematol.2019.216796","article-title":"Hereditary TTP Registry. The International Hereditary Thrombotic Thrombocytopenic Purpura Registry: Key findings at enrollment until 2017","volume":"104","author":"Taleghani","year":"2019","journal-title":"Haematologica"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"5888","DOI":"10.1182\/blood-2012-02-408914","article-title":"Unexpected frequency of Upshaw-Schulman syndrome in pregnancy-onset thrombotic thrombocytopenic purpura","volume":"119","author":"Garrec","year":"2012","journal-title":"Blood"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1182\/blood-2014-02-553131","article-title":"Thrombotic thrombocytopenic purpura and pregnancy: Presentation, management, and subsequent pregnancy outcomes","volume":"124","author":"Scully","year":"2014","journal-title":"Blood"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"2496","DOI":"10.1111\/jth.15010","article-title":"ISTH guidelines for treatment of thrombotic thrombocytopenic purpura","volume":"18","author":"Zheng","year":"2020","journal-title":"J. Thromb. Haemost."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1097\/AOG.0000000000005024","article-title":"Differentiating and Managing Rare Thrombotic Microangiopathies During Pregnancy and Postpartum","volume":"141","author":"Lim","year":"2023","journal-title":"Obstet. Gynecol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1056\/NEJMoa1414838","article-title":"Predictive value of the sFlt-1:PlGF ratio in women with suspected preeclampsia","volume":"374","author":"Zeisler","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1161\/HYPERTENSIONAHA.113.01787","article-title":"New gestational phase-specific cutoff values for the use of the soluble fms-like tyrosine kinase-1\/placental growth factor ratio as a diagnostic test for preeclampsia","volume":"63","author":"Verlohren","year":"2014","journal-title":"Hypertension"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1080\/10641950701521221","article-title":"Characteristic laboratory changes in pregnancies complicated by HELLP syndrome","volume":"26","author":"Hupuczi","year":"2007","journal-title":"Hypertens. Pregnancy"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1080\/10641955.2016.1218505","article-title":"Hemolysis, elevated liver enzymes, and low platelet syndrome: Outcomes for patients admitted to intensive care at a tertiary referral hospital","volume":"36","author":"Gedik","year":"2017","journal-title":"Hypertens. Pregnancy"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"2169","DOI":"10.1056\/NEJMoa1208981","article-title":"Terminal complement inhibitor eculizumab in atypical hemolytic-uremic syndrome","volume":"368","author":"Legendre","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1498","DOI":"10.1016\/S0140-6736(10)60709-X","article-title":"Antiphospholipid syndrome","volume":"376","author":"Crowther","year":"2010","journal-title":"Lancet"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1093\/qjmed\/hcm052","article-title":"Scleroderma renal crisis: Patient characteristics and long-term outcomes","volume":"100","author":"Penn","year":"2007","journal-title":"QJM"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1186\/s13075-016-1168-x","article-title":"Analysis of complement biomarkers in systemic sclerosis indicates a distinct pattern in scleroderma renal crisis","volume":"18","author":"Johansson","year":"2016","journal-title":"Arthritis Res. Ther."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1097\/GRF.0000000000000494","article-title":"Acute fatty liver of pregnancy","volume":"63","author":"Nelson","year":"2020","journal-title":"Clin. Obstet. Gynecol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"2041","DOI":"10.1056\/NEJMcp1113996","article-title":"Vitamin B12 deficiency","volume":"368","author":"Stabler","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1186\/1756-8722-1-26","article-title":"Hemolysis and hyperhomocysteinemia caused by cobalamin deficiency: Three case reports and review of the literature","volume":"1","author":"Acharya","year":"2008","journal-title":"J. Hematol. Oncol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/4\/352\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T13:55:42Z","timestamp":1760104542000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/4\/352"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,6]]},"references-count":75,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2024,2]]}},"alternative-id":["diagnostics14040352"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics14040352","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,6]]}}}