PP166. HELLP syndrome: Challenges for establishing diagnostic criteria

Preeclampsia is a public health problem which may manifest as pre-eclampsia (hypertension, proteinuria and/or edema) and eclampsia (convulsive crises and rarely coma in pregnant women with previous pre-eclampsia). But the pathology of hypertensive disease of pregnancy can present different clinical forms. Within that spectrum is HELLP syndrome: hemolysis (H), elevated liver enzymes (EL) and thrombocytopenia (LP).

To assess the diagnostic criteria in the literature adopted for HELLP syndrome.

A literature review on the Virtual Health Library with the keywords "HELLP syndrome" and "diagnosis" found 674 citations. Six hundred and thirty-four dismissed for failing to engage with the proposed question, and 43 articles remained. Twenty seven articles were excluded because of the language, unable in Latin America, letters, case report and articles published prior to 1999. Sixteen original articles were included. Eleven reviews, one prospective study, two cohorts, one retrospective cohort study and a cross. Studies were classified according to degree of recommendation and level of evidence.

The term clinical and laboratory markers were varied and their cut-off levels differ among the authors. The appearance of eclampsia, pain in the upper abdomen, nausea and significant proteinuria and other maternal morbidities were more frequent in patients with HELLP syndrome. The levels of lactic dehydrogenase, AST, and uric acid were further elevated in women with HELLP syndrome guarding correlation with the prognosis of the case. There is no consensus for the interpretation of laboratory values that may represent the most widespread occurrence of parameters: hemolytic anemia, elevated liver enzymes and thrombocytopenia. Other morbidities may have clinical signs, symptoms and laboratory abnormalities that mimic the syndrome.

There are many questions to establish standard diagnostic criteria for all patients with HELLP syndrome, necessitating studies consistent with significant population numbers to establish the main signs and symptoms and try to reach consensus on the best markers for the diagnosis and its proper indexes cutting.