HELLP syndrome

Background

• HELLP = Hemolysis, Elevated LFTS, Low Platelets
• Clinical variant of preeclampsia
• Any pt >20wk gestation or <4wk postpartum c/o abd pain should receive HELLP w/u
• Usually presents w/in 48 hr of delivery
• 80% of pts have no evidence of preeclampsia before delivery

Diagnosis

• Signs/Symptoms
  • RUQ or epigastric pain - 40-90%
  • Proteinuria - 86-100%
  • Hypertension - 82-88%
• Labs
  • CBC w/ diff
    • Microangiopathic hemolytic anemia
    • Plt count <100
  • LFT
    • AST > 70, bilirubin > 1.2
  • LDH > 600

Work-Up

1. CBC
   1. Schistocytes
   2. Thrombocytopenia
2. LFT
   1. AST, ALT elevation (although usually <500)
3. Chemistry
   1. Normal or elevated BUN/Cr
4. Coags
   1. Abnormal
5. CT or US to check for hepatic hematoma (if needed)

Differential Diagnosis

3rd Trimester/Postpartum Emergencies

• Acute fatty liver of pregnancy
• Amniotic fluid embolus
• Chorioamnionitis
• Eclampsia
• HELLP syndrome
• Mastitis
• Peripartum cardiomyopathy
• Postpartum endometritis (postpartum PID)
• Postpartum headache
• Postpartum hemorrhage
• Preeclampsia
• Resuscitative hysterotomy
• Retained products of conception
• Septic abortion
• Uterine rupture

Treatment

1. Similar to that of severe preeclampsia or eclampsia
   1. Magnesium
   2. BP control
   3. Coagulopathy correction
      1. Transfuse platelets if < 20,000 or active, uncontrolled bleeding

Complications

1. DIC
2. Acute renal failure
3. Subcapsular liver hematoma
   1. Abdominal distention
   2. Maintain adequate intravascular volume
      1. If unstable consider embolization vs surgery

See Also

• Post-Partum Emergencies

Source

• Tintinalli
• EBM, Volume 12, Number 8, Aug 2010. Postpartum Emergencies
• Uptodate