From the Guidelines
Laboratory tests for pre-eclampsia should include a full blood count, liver enzymes, serum creatinine, electrolytes, uric acid, urinalysis, and microscopy, as well as PCR or albumin: creatinine ratio, according to the ISSHP recommendations 1. When evaluating patients for pre-eclampsia, it is essential to consider the potential for white-coat hypertension, which can be avoided by using repeated BP readings and having clinic or office BP recorded by a nurse rather than a doctor 1. Key laboratory tests for pre-eclampsia include:
- A full blood count to check for hemolysis and thrombocytopenia
- Liver enzymes, such as aspartate aminotransferase, alanine aminotransferase, and lactate dehydrogenase, to evaluate liver function
- Serum creatinine, electrolytes, and uric acid to assess kidney function
- Urinalysis and microscopy, as well as PCR or albumin: creatinine ratio, to detect proteinuria
- Renal ultrasound if serum creatinine or any of the urine testing are abnormal 1. These tests help diagnose pre-eclampsia and assess its severity, allowing for prompt management and prevention of complications. Regular monitoring of these parameters is crucial, especially in severe cases, as pre-eclampsia can rapidly progress to complications like HELLP syndrome or eclampsia 1.
From the Research
Laboratory Tests for Preeclampsia
- Serum uric acid and liver function tests, such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST), can be used as biomarkers for preeclampsia-related organ damage 2
- Abnormalities in uric acid and liver enzymes are relatively rare in patients with preeclampsia, and laboratory data may add little to the clinical diagnosis 3
- Liver and kidney function tests, including serum albumin, total bilirubin, alkaline phosphatase (ALP), AST, ALT, and gamma-glutamyl transaminase (GGT), can be used to assess hepatic function, while serum creatinine, urea, and uric acid can be used to assess renal function 4
Diagnostic Criteria
- Preeclampsia is characterized by new-onset hypertension and proteinuria, or any indication of end-organ damage, after 20 weeks of gestation 2
- The disease can cause liver and kidney dysfunction, thrombocytopenia, pulmonary edema, and neurologic dysfunction 2, 5
- Coagulopathy can occur in women with preeclampsia, predisposing them to bleeding complications 6
Screening Recommendations
- Routine screening for preeclampsia may not require liver function and uric acid testing, as abnormalities are relatively rare 3
- Renal tests, such as serum creatinine and urea, may be more useful in screening for preeclampsia, as abnormalities are more common 3
- Coagulation testing, such as activated partial thromboplastin time (aPTT) and international normalized ratio (INR), may be useful in identifying women with preeclampsia who are at risk of bleeding complications 6