HELLP Syndrome (Complete) Flashcards
Define HELLP syndrome
Complication of pregnancy characterised by:
Hemolysis (H)
Elevated liver enzymes (EL)
Low platelets (LP)
What is the prevalence of HELLP syndrome?
0.5-0.9%
Rare but is a significant cause of maternal/perinatal morbidity and mortality
HELLP syndrome is closely linked to which other obsteric condition?
Pre-eclampsia
10-20% of patients with severe pre-eclampsia will develop HELLP
What are the main clinical features of HELLP syndrome?
Abdominal pain (due to liver ischaemia/necrosis)
* Epigastric
* RUQ
Nausea and vomitting
Generalised malaise/lethargy
Pre-eclampsia:
* Hypertension
* Oedema
* Headache
* Visual disturbance
What investigations should be conducted in patients with suspected HELLP syndrome?
Bedside:
Basic obs: Hypertension
Urinalysis: Proteinuria
Bloods:
FBC: Thrombocytopenia
Peripheral blood smear: Schistocytes (haemolysis)
Coagulation screen: Check for DIC
U&Es: Elevated urea
Billurubin: Both total and unconjugated billirubin raised
LFTs: Elevated AST + ALT
Lactate dehydrogenase (LDH): Elevated (haemolysis)
Imaging:
Abdominal ultrasound: Check for alternative causes of RUQ pain
Foetal ultrasound: Check for growth restriction
What investigation findings are indicative of HELLP syndrome?
Thrombocytopenia
Haemolysis (Schistocytes + elevated LDH)
Elevated AST ALP
How are patients with HELLP managed?
Medicine:
IV magnesium sulfate: Seizure prophylaxis
IV labetalol or oral nifedipine: Hypertension management
IV dexamethasone: For foetal lung maturation and maternal benefit before and after delivery
Platelets +/or FFP or cyroprecipitate: Correction of coagulopathy if indicated
Blood transfusion: Correction of anaemia if indicated
Interventional:
Delivery of foetus: Definitive management
What can be given as prophylaxis against seizures in patients with HELLP syndrome?
IV magnesium sulfate
What is given to manage hypertension in patients with HELLP?
IV labetalol
OR
Oral nifedipine
Nifedipine should always be given in asthmatics
What is the definitive mangement for HELLP syndrome?
Delivery of foetus
Which differentials should be considered alongside HELLP syndrome?
TTP
How can TTP be distinguished from HELLP syndrome?
Can be clinically indistiguishable
Jaundice, petechiae, purpura, or other abnormal bleeding more common
LDH significantly higher compared to liver transaminases versus HELLP
TTP: LDH:aspartate aminotransferase ratio is >22
HELLP: LDH:aspartate aminotransferase ratio is <22
