Differential Diagnosis
- Single most likely diagnosis
- Preeclampsia: This diagnosis is the most likely due to the patient's presentation of hypertension (BP of 161/95 mm Hg), right upper quadrant pain, and significant proteinuria (4+ protein on urinalysis) at 32 weeks gestation. The presence of thrombocytopenia (platelets of 95,000/µL) and hemolysis (indicated by a low hemoglobin of 8.1 mg/dL) also supports this diagnosis, as preeclampsia can lead to HELLP syndrome, a variant characterized by hemolysis, elevated liver enzymes, and low platelet count.
- Other Likely diagnoses
- Hemolysis, elevated liver enzymes, and low platelet count syndrome (HELLP syndrome): Given the patient's low platelet count, hemolysis, and the context of preeclampsia, HELLP syndrome is a strong consideration. It is essentially a variant of preeclampsia and shares many of its risk factors and clinical features.
- Gestational hypertension: While this could be a consideration due to the patient's hypertension, the presence of significant proteinuria and other systemic symptoms (thrombocytopenia, hemolysis) points more towards preeclampsia or HELLP syndrome.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Intrahepatic cholestasis of pregnancy: Although less likely given the patient's presentation, intrahepatic cholestasis of pregnancy can cause right upper quadrant pain and should be considered, especially if liver enzymes are elevated. However, the primary symptoms and lab findings in this case more strongly suggest preeclampsia or HELLP syndrome.
- Immune thrombocytopenia: This condition could explain the thrombocytopenia but does not account for the hypertension, proteinuria, or hemolysis. It's less likely but should be considered in the differential due to its potential for significant morbidity if not recognized.
- Rare diagnoses
- Other rare conditions that could potentially cause similar presentations, such as thrombotic thrombocytopenic purpura (TTP) or hemolytic uremic syndrome (HUS), are less likely given the clinical context and the specific combination of symptoms and lab findings presented. However, they should be kept in mind for patients who do not fit neatly into the more common diagnoses.