HELLP Syndrome

1. HELLP SYNDROME

2. Definition
 Can be used to describe preeclampsia in association with
 HEMOLYTIC ANEMIA
 ELEVATED LIVER ENZYMES
 LOW PLATELET COUNT
 Any patient diagnosed with HELLP syndrome should be considered to have severe
preeclampsia

3. HELLP triad
 HEMOLYSIS
 Abnormal peripheral smear results with burr cells and schistocytes
 ELEVATED LIVER ENZYMES
 LOW PLATELET COUNT/ THROMBOCYTOPENIA
 Less than 100000 /mm3

4. CLINical features
 Most cases are vague and are missable
 SYMPTOMS
 RUQ pain or pain around stomach
 Nausea
 Headache
 Malaise
 Signs
 RUQ tenderness
 Increased BP
 Proteinuria
 Edema

5. Diagnostic criteria
 Hemolytic anemia (H)
 Schizocytosis, RBC fragments
 Bilirubin >1.2 mg/dl
 Elevated liver enzymes (EL)
 SGOT serum glutamic oxaloacetic transaminase >72 IU/L
 LDH > 500 IU/L
 Low platelet count (LP)
 <100000 mm3

6. Risk factors
 Age
 Older than 34
 Multiparity
 White race/ Europeans
 Poor pregnancy outcome history

7. Severity classification
 I severe
 Platelets <50000 mm3
 Altered liver enzymes
 Evidence of hemolysis
 II moderate
 Platelets 50000-10000
 III mold
 Platelets 100000-150000

8. Differentials
 Can be confused with many medical conditions
 Biliary colic and cholecystitis
 ITP
 GERD and Peptic ulcer disease
 Acute fatty liver of pregnancy
 Appendicitis
 Cerebral hemorrhage

9. Complications
 Eclampsia
 Abruptio placentae
 DIC
 Acute renal failure
 Severe ascites
 Cerebral edema
 Pulmonary edema

10. MANAGEMENT PLAN
Identification - clinical features
- lab findings
- D/D from other condition
Admission to hospital Stabilization
•IV line ,Cross match
•Catheterization
•Respi assessment
Fetal assessment
(NST,BPP,Color doppler )
Transport to tertiary
care centre or latency
for 24-48 hrs
Termination of
pregnancy
Conservative approach for 48-72
hrs (<32wks POG, Partial
HELLP,Tertiary health cenre)
Rebound / Resolution ●Monitor by lab Ix
●Stop MgSO4 24 hrs of delivery
●Continue antihypertensive & steroid

12. Conservative management
 Mild to moderate
 Control of BP
 Prevent eclamptic fits
 Give magnesium sulfate
 Prevents HELLP progression (decreases platelet and RBC effects)
 Corticosteroids to improve platelet and liver function
 Fluid therapy
 Ringer’s lactate with glucose and saline at 100ml/h
 Platelet transfusion

13. Conservative management continued
 Platelet transfusion
 Needed before or after delivery
 Replenish blood loss from bleeding sites , that is, from
 Puncture sites
 Wounds
 Intraperitoneal bleeding

14. Postpartum care
 If discovered postpartum, admit to obstetric ICU
 Control bp (diastolic less than 1000mm/hg
 Urine output >100ml/h
 Platelet increase and LDH decrease
 Clinical improvement in any cases