[HELLP syndrome: the ten commandments]

Area of Science:

• Obstetrics and Gynecology
• Internal Medicine
• Hematology

Background:

• HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) is a severe condition complicating pregnancy.
• It presents with diverse symptoms, making early diagnosis challenging.
• Differential diagnosis includes thrombotic microangiopathy.

Observation:

• Epigastric pain in late pregnancy is a key symptom of HELLP syndrome.
• Liver dysfunction and thrombocytopenia can occur without renovascular issues.
• The condition poses significant risks to both mother and fetus.

Findings:

• Prompt termination of pregnancy is the primary treatment.
• Steroid therapy may facilitate anesthesia and reduce transfusion needs.
• Early-onset HELLP syndrome may indicate underlying chronic nephropathy or thrombophilia.

Implications:

• Internists play a vital role in managing pregnancy-associated HELLP syndrome.
• Multidisciplinary collaboration between internists and obstetricians improves patient outcomes.
• Understanding HELLP syndrome aids in identifying at-risk pregnancies and potential long-term maternal health issues.