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QuestionChoice
HELLP (Haemolysis, Elevated Liver enzymes and Low Platelets) syndrome is a severe life-threatening condition in pregnancy. This patient has evidence of haemolysis (low haemoglobin, elevated bilirubin), elevated liver enzymes and low platelets. She is not hypertensive, however this may be accounted for by the fact she is already on labetalol, and she is clinically dehydrated. HELLP syndrome can occur in the absence of hypertension and proteinuria.
49857
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HELLP syndrome
QuestionChoice
Gestational hypertension is diagnosed where there is new-onset hypertension, without proteinuria or evidence of pre-eclampsia. Whilst this woman does have gestational hypertension, the diagnosis which encompasses all of her findings is HELLP syndrome.
49859
c
Gestational hypertension
QuestionChoice
Pre-eclampsia is defined as new-onset hypertension in pregnancy accompanied by proteinuria. Pre-eclampsia is not associated with thrombocytopenia.
49860
d
Acute hepatitis
QuestionChoice
Pre-eclampsia is defined as new-onset hypertension in pregnancy accompanied by proteinuria. Pre-eclampsia is not associated with thrombocytopenia.
49858
b
Pre-eclampsia
QuestionChoice
Hyperemesis gravidarum typically occurs in the first trimester, and whilst it may present with tachycardia and hypotension if profound dehydration, it does not cause thrombocytopenia or deranged liver function tests.
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Hyperemesis gravidarum
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i aint reading all that 
i'm happy for u tho
or sorry that happened
25737
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Dominant Tazocin
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Please i really need some more blood results please please please can you include her thyroid function tests and if you are being so kind maybe a full renal screen.
26914
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Dermis Cystic
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# Summary

HELLP syndrome is a severe pregnancy complication characterized by hemolysis (H), elevated liver enzymes (EL), and low platelets (LP). It typically manifests during the third trimester and is part of a spectrum of hypertensive disorders of pregnancy, including preeclampsia. Key signs and symptoms include headache, nausea/vomiting, epigastric pain, right upper quadrant abdominal pain, blurred vision, and peripheral edema. Investigations may include blood tests and ultrasound scans. The definitive treatment is usually the delivery of the baby, with some mothers also requiring blood transfusions or steroids during pregnancy.


# Definition


HELLP syndrome is a complication of pregnancy characterized by the presence of hemolysis (H), elevated liver enzymes (EL), and low platelets (LP). It often manifests during the third trimester and is considered part of a spectrum of hypertensive disorders of pregnancy, which also includes preeclampsia.


# Epidemiology



HELLP syndrome is relatively rare, affecting approximately 0.5-0.9% of all pregnancies. However, it is a significant cause of maternal and perinatal morbidity and mortality.


# Aetiology



The exact cause of HELLP syndrome is unknown. However, it is believed to be related to abnormal placentation, endothelial cell injury, and a generalized inflammatory response. Genetic predisposition and immune maladaptation may also play roles.


# Signs and Symptoms



Patients with HELLP syndrome may present with:

- Headache
- Nausea and/or vomiting
- Epigastric pain
- Right upper quadrant abdominal pain due to liver distension
- Blurred vision
- Peripheral edema


# Differential Diagnosis



The differential diagnoses for HELLP syndrome include acute fatty liver of pregnancy, idiopathic thrombocytopenic purpura, and thrombotic thrombocytopenic purpura. These conditions can also present with similar signs and symptoms such as thrombocytopenia, liver dysfunction, and neurological symptoms.

# Complications

Maternal complications include:

- Organ failure
- Placental abruption
- Disseminated intravascular coagulopathy (DIC).

Foetal complications include:

- Intrauterine growth restriction
- Preterm delivery
- Neonatal hypoxia


# Investigations


Investigations for HELLP syndrome may include:

- Full blood count to assess for low platelet count and evidence of hemolysis
- Liver function tests to assess for elevated liver enzymes
- Coagulation studies to evaluate for disseminated intravascular coagulation
- Ultrasound scans to assess for liver abnormalities and placental abruption

# Management


The definitive treatment for HELLP syndrome is usually the delivery of the baby. In some cases, mothers may also require blood transfusions to manage anemia and thrombocytopenia or steroids to accelerate lung maturation in the fetus prior to delivery. After delivery, supportive care and close monitoring are essential.
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HELLP syndrome
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A 24-year-old primigravida at 36 weeks gestation presents with 5 days of vomiting and inability to tolerate oral fluids. Her past medical history includes hypothyroidism and gestational hypertension.
She takes the following medications:



  - Labetalol 200mg three times daily
  - Levothyroxine 175micrograms once daily
  - Ferrous fumarate 210mg twice daily



On examination, she looks clinically dehydrated and has a heart rate of 100 bpm.



A cardiotocograph is reassuring.



Her full blood count tests are as follows:


||||
|--------------|:-------:|---------------|
|Haemoglobin|101 g/L|(M) 130 - 170, (F) 115 - 155|
|White Cell Count|6.5 x10<sup>9</sup>/L|3.0 - 10.0|
|Platelets|100x10<sup>9</sup>/L|150 - 400|





Her liver function tests are as follows:



||||
|---------------------------|:-------:|--------------------|
|Albumin|31 g/L|35 - 50|
|Alanine Aminotransferase (ALT)|150IU/L|10 - 50|
|Aspartate Aminotransferase (AST)|120 IU/L|10 - 40|
|Alkaline Phosphatase (ALP)|210 IU/L|25 - 115|
|Bilirubin|32 µmol/L|< 17|
|Gamma Glutamyl Transferase (GGT)|42 U/L|9 - 40|
|Lactate Dehydrogenase|642 IU/L|70 - 250|



She is unable to provide a urine sample for urinalysis.



What is the most likely diagnosis?
a