HELLP syndrome

HELLP syndrome is a pregnancy-related condition and is an abbreviation for:

  • haemolysis
  • elevated liver enzymes and 
  • low platelets

It is considered a severe and life-threatening form of pre-eclampsia although it can occur without co-existing pre-eclampsia. 

The estimated incidence is  ~0.5% (range 0.17-0.85%) of live births 9. The condition often occurs in the 3rd trimester of pregnancy (and occasionally postpartum). It tends to present in young primigravid women. 

The presentation can be variable and can include malaise, epigastric/right upper-quadrant pain, and nausea/vomiting. Some may have non-specific viral-like symptoms. Hypertension and proteinuria (classic symptoms of preeclampsia) may be absent or slight 7

The etiology and pathophysiology remain incompletely understood with multiple theories 12:

On liver histology, there is may a combination of deposited fibrin, hemorrhage and hepatocellular necrosis surrounding portal areas 6

The place of CT is mainly to assess for complications. When considering a CT scan the radiologist needs to discuss with the obstetrician regarding radiation risk to fetus from radiation, versus clinical suspicion of complications in order to make a rational judgment. The CT scan may show hepatic complications such as hemorrhage, rupture, subcapsular hematoma or hepatic infarction.

Management is often supportive. Patients with hepatic rupture +/- intraperitoneal bleeding require immediate surgery or selective hepatic arterial embolization

The condition was originally described Pritchard et al. in 1954 3 with the acronym later coined by L Weinstein in 1982 4.

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Article information

rID: 12561
Section: Syndromes
Synonyms or Alternate Spellings:
  • Haemolysis, elevated liver enzymes and low platelets

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