The HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets): much ado about nothing?

Article Abstract:

Preeclampsia is a condition of pregnancy characterized by swelling, high blood pressure and protein in the urine. Red blood cell destruction (hemolysis), abnormal liver function tests and low blood platelets (cells involved in blood clotting mechanism), collectively termed HELLP syndrome, can also be found in patients with preeclampsia. It is unclear whether the HELLP syndrome is a separate condition or only part of the clinical picture of preeclampsia. The controversy surrounding the diagnosis of preeclampsia and HELLP syndrome prompted a review of criteria that can be used to differentiate between the two conditions. It has been suggested by some researchers that HELLP syndrome may be related to disseminated intravascular coagulation (DIC), which involves abnormal clotting. Patients with HELLP syndrome usually complain of pain in the upper right quadrant of the body (90 percent of the patients). Nausea and vomiting are reported in 50 percent of the patients and malaise in 90 percent of the patients. Symptoms appear by the 36th week of pregnancy. Patients often have viral-like symptoms and may appear jaundiced. They may or may not have high blood pressure and protein in the urine. The mortality rate of the mothers ranges from 0 to 24 percent, while fetal mortality ranges from 7.7 to 60 percent. The outcome of the fetus is generally poor, many suffering from growth retardation. Treatments include increasing the blood volume, administration of clot-preventing agents and steroids, and blood transfusions. All women with these symptoms should have a complete blood count, platelet count and tests measuring liver enzymes to determine liver functioning, regardless of blood pressure. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Causes of, Development and progression, Blood clotting disorders, Blood coagulation disorders, Pregnancy, Thrombocytopenia, Hematologic diseases, Blood diseases in pregnancy

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Pregnancies complicated by HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets): subsequent pregnancy outcome and long-term prognosis

Article Abstract:

Women who have had the HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) in a previous pregnancy are likely to experience serious complications in a subsequent pregnancy but are not likely to reexperience the HELLP syndrome. The HELLP syndrome is a rare and extreme complication of pregnancy hypertension. A group of 152 women who returned to normal blood pressure after pregnancy had 192 pregnancies afterwards. Nineteen percent of them developed preeclampsia, 21% had a preterm birth, 12% had intrauterine growth retardation (IUGR), 2% had a placental abruption, 4% had a perinatal death, and 3% redeveloped the HELLP syndrome. Thirteen women who had chronic hypertension had 20 pregnancies. Seventy-five percent of then developed preeclampsia, 80% had a preterm birth, 45% had IUGR, 20% had a placental abruption, 40% had a perinatal death, and 5% redeveloped the HELLP syndrome. Ninety-eight women with normal blood pressure took oral contraceptives with no complications, suggesting that oral contraceptives are do not cause problems among this group.

Complications and side effects, Risk factors, Eclampsia

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Clinical utility of strict diagnostic criteria for the HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome

Article Abstract:

It may be important to precisely distinguish pregnant women with all of the HELLP syndrome characteristics including hemolysis, elevated liver enzymes, and low platelets from those with only a few of these characteristics. Hemolysis is the breakdown of red blood cells. Researchers compared the medical records of 67 pregnant women with HELLP, 71 with partial HELLP, and 178 with severe preeclampsia and none of the HELLP characteristics. Women with the complete HELLP syndrome were more likely to develop blood clots, need a transfusion, or deliver by cesarean than those with partial HELLP or severe preeclamsia.

Care and treatment

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