A. Acute fatty liver of pregnancy – Explanation

Acute fatty liver of pregnancy (AFLP) and HELLP (Haemolysis, Elevated Liver
enzymes,Low Platelets) syndrome both have low platelets and deranged liver function
as part ofthe clinical picture. However, low serum glucose and/or raised serum

ammonia aremore suggestive of AFLP. Vomiting is also more commonly seen in AFLP
than HELLPsyndrome.

Acute fatty liver of pregnancy
Acute fatty liver of pregnancy (AFLP) is a rare form of jaundice in pregnancy. It
occurslate in pregnancy and may be life-threatening. The aetiology of AFLP is unknown.
It ispart of the spectrum of disorders related to pre-eclampsia. Differentiation from
HELLP(Haemolysis, Elevated Liver enzymes, Low Platelets) syndrome can be difficult
as signs
and symptoms can overlap.

Risk factors
• Pre-eclampsia → There is associated pre-eclampsia in 30–60% of AFLP
• First pregnancies
• Multiple pregnancy

Presentation
• Presents acutely with:
o Nausea
o Vomiting
o Abdominal pain
o Fevers
o Headache
o Pruritus
o Jaundice
• Begins typically after 30 weeks of gestation
• It also may also appear immediately after delivery
Severe hypoglycaemia and clotting disorder may develop causing coma and death

Investigations
• Liver transaminases are elevated (ALT is typically elevated more than 500 U/L)
• Raised serum bilirubin
• Hypoglycaemia
•Abnormal clotting with coagulopathy (prolongation of prothrombin and partial
thromboplastin times)
• Biopsy would be diagnostic

Management (Unlikely to be asked in detail for the level of PLAB exam)
• Treat hypoglycaemia
• Correct clotting disorders
• N-acetylcysteine (NAC) (Unlicensed use)
• Consider early delivery A

DIFFERENTIATING AFLP FROM HELLP
Acute fatty liver of pregnancy vs Haemolysis, Elevated Liver Enzymes, Low Platelets

syndrome
It is unlikely you would need to know all the different features of HELLP and AFLP for
the level of the PLAB exam as even senior medical and obstetric teams often have
difficulty telling them apart in a clinical setting, however, this table is inserted for those
who would like to understand how to differentiate them for your own clinical knowledge