HELLP SYNDROME

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

HELLP triad

HEMOLYSIS Abnormal peripheral smear results with burr cells and schistocytes

ELEVATED LIVER ENZYMES LOW PLATELET COUNT/ THROMBOCYTOPENIA

Less than 100000 /mm3

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

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

Risk factors

Age Older than 34

Multiparity White race/ Europeans Poor pregnancy outcome history

Severity classification

I severe Platelets <50000 mm3 Altered liver enzymes Evidence of hemolysis

II moderate Platelets 50000-10000

III mold Platelets 100000-150000

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

Complications

Eclampsia Abruptio placentae DIC Acute renal failure Severe ascites Cerebral edema Pulmonary edema

MANAGEMENT PLANIdentification - 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

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

Conservative management continued

Platelet transfusion Needed before or after delivery Replenish blood loss from bleeding sites , that is, from

Puncture sites Wounds Intraperitoneal bleeding

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

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