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
- CBC w/ diff
Work-Up
- CBC
- Schistocytes
- Thrombocytopenia
- LFT
- AST, ALT elevation (although usually <500)
- Chemistry
- Normal or elevated BUN/Cr
- Coags
- Abnormal
- CT or US to check for hepatic hematoma (if needed)
Treatment
- Similar to that of severe preeclampsia or eclampsia
- Magnesium
- BP control
- Coagulopathy correction
- Transfuse platelets if < 20,000 or active, uncontrolled bleeding
Complications
- DIC
- Acute renal failure
- Subcapsular liver hematoma
- Abdominal distention
- Maintain adequate intravascular volume
- If unstable consider embolization vs surgery
See Also
Source
- Tintinalli
- EBM, Volume 12, Number 8, Aug 2010. Postpartum Emergencies
- Uptodate