QuestionSBA
QuestionChoice
This is a normal physiologic finding in pregnancy. In HELLP syndrome, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are typically elevated ≥2 times the upper limit of normal
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b
Elevated ALP 2 times the upper limit of normal
QuestionChoice
In HELLP syndrome, LDH is typically elevated ≥600 IU/L, a non-specific marker associated with severe haemolysis or acute hepatocellular injury
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e
Normal lactate dehydrogenase (LDH)
QuestionChoice
In HELLP syndrome, the PT, APTT and coagulation screen are normal. If prolonged, this may suggest disseminated intravascular coagulation, which is one complication of HELLP syndrome
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c
Prolonged prothrombin time (PT)/activated partial thromboplastin clotting time (APTT)
QuestionChoice
Haptoglobin level is a specific marker of haemolysis, and a level of ≤25mg/dL would suggest haemolysis which occurs in HELLP syndrome
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a
Low serum haptoglobin
QuestionChoice
This is typical of glucose-6-phosphate dehydrogenase (G6PD) deficiency. In HELLP syndrome, the usual finding is schistocytes and burr cells, which are fragmented red blood cells indicating microangiopathic haemolytic anaemia
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d
Peripheral blood film showing blister and bite cells
QuestionComment
RBC is broken down into LDH and Hb
Hb is carried in the blood by haptoglobin
Low levels of haptoglobin imply it's saturated by Hb

Also, haptoglobin is reduced in haemochromatosis
It is an acute phase reactant (like ferritin), and will be raised in states of inflammation and infection
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QuestionComment
To make it simple:
In HELLP you get haemolysis.
Haemolysis --> More free Haemoglobin --> More Haptoglobin binds to Haemoglobin to prevent toxic effects --> Less serum haptoglobin available
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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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In HELLP syndrome, low serum haptoglobin levels indicate haemolysis.
A 38 year old pregnant female at 32 weeks gestation presents to Maternity Triage with mild upper abdominal pain, vomiting and blurred vision. Her observations are normal, and cardiotocograph reveals no abnormalities with the foetus. Urinalysis is normal.

Which one of the following laboratory findings is most likely in HELLP (haemolysis, elevated liver enzymes, and low platelets) syndrome?
a