HELLP syndrome

Background

  • 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

  • RUQ or epigastric pain (40-90%)
  • Proteinuria (86-100%)
  • Hypertension (82-88%)

Differential Diagnosis

Postpartum Emergencies

Microangiopathic Hemolytic Anemia (MAHA)

Evaluation

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
  • LFT
    • 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)
  • 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

Management

Disposition

  • Admit

Complications

See Also

References