HELLP syndrome

HELLP syndrome is a serious, life-threatening complication of pregnancy characterized by three main features: Hemolysis (the breakdown of red blood cells), Elevated Liver enzymes (indicating liver damage), and Low Platelet count (thrombocytopenia). The name HELLP is an acronym derived from these three hallmark findings. It is generally considered a severe variant of preeclampsia, though it can occasionally occur without preceding signs of preeclampsia. HELLP syndrome primarily affects the hematologic system and the liver, and can lead to dangerous complications including placental abruption, disseminated intravascular coagulation (DIC), acute kidney injury, liver rupture or hematoma, pulmonary edema, and stroke. It typically develops during the third trimester of pregnancy (most commonly between 28 and 36 weeks of gestation), though it can also present in the early postpartum period. Key symptoms include upper abdominal or right upper quadrant pain, nausea and vomiting, malaise, headache, visual disturbances, and edema. Some patients may also experience hypertension and proteinuria consistent with preeclampsia. Laboratory findings reveal microangiopathic hemolytic anemia with schistocytes on blood smear, elevated liver transaminases (AST and ALT), elevated lactate dehydrogenase (LDH), and a platelet count below 100,000/μL. The condition can deteriorate rapidly and poses significant risks to both the mother and the fetus, including preterm birth, intrauterine growth restriction, and fetal or maternal death if not promptly managed. The definitive treatment for HELLP syndrome is delivery of the baby and placenta, which leads to resolution of the syndrome in most cases. Management decisions regarding timing of delivery depend on gestational age, severity of the condition, and maternal and fetal status. Supportive care may include blood transfusions, platelet transfusions, corticosteroids (such as dexamethasone, which may temporarily improve platelet counts and are used for fetal lung maturation if delivery is anticipated before 34 weeks), antihypertensive medications, and magnesium sulfate for seizure prophylaxis. Close monitoring in an intensive care setting is often required. The exact etiology of HELLP syndrome remains incompletely understood, but it is thought to involve abnormal placentation, endothelial dysfunction, and immune-mediated mechanisms. Risk factors include a history of preeclampsia or HELLP syndrome in a prior pregnancy, advanced maternal age, multiparity, and obesity.

Data sourced from FDA regulatory filings and ClinicalTrials.gov. Updated periodically.

Common questions about HELLP syndrome