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separate entity
may it be a separate
entity?
yes
• HELLP, a syndrome characterized by
hemolysis, elevated liver enzyme
levels and a low platelet count, is an
obstetric complication that is frequently
misdiagnosed at initial presentation. Many
investigators consider the syndrome to be
a variant of preeclampsia,
Martin JN Jr, Rinehart BK, May WL, Magann EF, Terrone DA,
Blake PG.
Laboratory Diagnostic Criteria for
HELLP syndrome
Haemolysis
Abnormal peripheral smear : spherocytes, schistocytes,
triangular cells and burr cells
Total Bilirubin level > 1.2 mg/dL
Lactate dehydrogenase level > 600U/L
Elevated liver function test result
Serum aspartate amino transferase level > 70U/L
Lactate dehydrogenase level >600 U/L
Low platelet count
Platelet count < 150 000/mm3
Platelet count
appears to be the
most reliable
indicator of the
presence of HELLP
syndrome
Clinical utility of strict diagnostic
criteria for the HELLP
Magann EF, Bass D, Chauhan SP, Sullivan DL, Martin RW, Martin JN Jr. Am
J Obstet Gynecol 1994;171:1148-53.
• Corticosteroid therapy should be
instituted in patients with HELLP
syndrome who have a platelet count of
less than 100,000 per mm3 .And should
be continued until liver function
abnormalities are resolving and the
platelet count is greater than 100,000 per
mm3
Portis R, Jacobs MA, Skerman JH, Skerman EB. HELLP syndrome (hemolysis, elevated
liver enzymes, and low platelets) pathophysiology and anesthetic considerations. AANA
J 1997;65:37-47.
Complications
Complications
The mortality rate for women with HELLP
syndrome is approximately 1.1 %
From 1 to 25 % of affected women develop
serious complications such as DIC, placental
abruption, adult respiratory distress syndrome,
hepatorenal failure, pulmonary edema,
subcapsular hematoma and hepatic rupture.
A significant percentage of patients receive
blood products.
Sibai BM, Ramadan MK, Usta I, Salama M, Mercer BM, Friedman SA. Maternal
morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes,
and low platelets (HELLP syndrome). Am J Obstet Gynecol 1993;169:1000-6.
Complications
Infant morbidity and mortality rates range
from 10 to 60 %, depending on the severity of
maternal disease.
50.00%
40.00%
25%
30.00%
20.00%
10.00% 1.10%
0.00%
matern.mort. maternal fetal
complication complication
take home
Once the diagnosis of HELLP
syndrome has been established, the
best markers to follow are the
maternal lactate dehydrogenase
level and
the maternal platelet count
take home
• The laboratory abnormalities in
HELLP syndrome typically
worsen after delivery and then
begin to resolve by three to four
days postpartum.
Martin JN Jr, Blake PG, Perry KG Jr, McCaul JF, Hess LW, Martin RW.
The natural history of HELLP syndrome: patterns of disease progression
and regression. Am J Obstet Gynecol 1991;164(6 pt 1):1500-9.
take home
The incidence of hemorrhagic
complications is higher when
platelet counts are < 40,000
per mm3
take home
Patients with HELLP syndrome who
complain of severe right upper
quadrant pain, neck pain or shoulder
pain should be considered for hepatic
imaging regardless of the severity of
the laboratory abnormalities, to assess
for subcapsular haematoma or rupture
take home
• Patients with HELLP
syndrome should be
routinely treated with
corticosteroids.