HELLP syndrome

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  • HELLP = Hemolysis, Elevated LFTs, Low Platelets
  • Clinical variant of preeclampsia
  • Any patient >20wk gestation or <4wk postpartum complaining of abdominal pain should receive HELLP workup
  • When occurring postpartum, typically presents within 48hr of delivery
  • 80% of patients have no evidence of preeclampsia before delivery

Clinical Features


Differential Diagnosis

3rd Trimester/Postpartum Emergencies

Microangiopathic Hemolytic Anemia (MAHA)


Differential diagnosis of hyperbilirubinemia.

Indirect Hyperbilirubinemia

Direct (Conjugated) Hyperbilirubinemia

Hepatocellular damage

Patient will have severely elevated AST/ALT with often normal Alkaline Phosphatase

Pregnancy Related

Transplant Related

Pediatric Related

Additional Differential Diagnosis


Only bilirubin stains the sclera

  • Carotenemia
  • Quinacrine ingestion
  • Dinitrophenol, teryl (explosive chemicals)


Evaluation is targeted at assessing the individual components of the syndrome. Labs to be drawn should include a:

  • CBC
  • Chemistry
    • Normal or elevated BUN/Cr
  • Coagulation panel (fibrinogen can be decreased and PTT elevated)
    • Patients can progress towards DIC
  • LFTs
    • AST levels > 150 IU/L and ALT levels > 100 IU/L (also often associated with bilirubin > 1.2mg/dL
    • LDH elevation (often > 600 IU/L)
  • UA (proteinuria)
  • CT or ultrasound can be considered if there is pain requiring a greater workup.
    • Depending on degree of thrombocytopenia are at risk for developing intraabdominal bleeding such as a hepatic hematoma



  • Admit

See Also