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HELLP syndrome: a diagnostic conundrum with severe complications

Devika Rao1, Nikulkumar Kumar Chaudhari2, Robert Michael Moore3

  • 1Department of Medicine, Jacobi Medical Center, Bronx, New York, USA.

BMJ Case Reports
|August 19, 2016
PubMed

Insights

HELLP syndrome, a severe form of pre-eclampsia, presents significant maternal and fetal risks. This case highlights a patient’s recovery from HELLP syndrome with acute kidney injury through intensive supportive care.

Area of Science:

  • Obstetrics and Gynecology
  • Critical Care Medicine
  • Hematology

Background:

  • HELLP syndrome (haemolysis, elevated liver enzymes, low platelets) is a severe obstetric complication, often considered within the spectrum of hypertensive disorders of pregnancy.
  • It is associated with higher maternal and fetal morbidity compared to pre-eclampsia alone.

Observation:

  • A 26-year-old primigravida woman at 35 weeks gestation presented with HELLP syndrome, marked transaminitis, and mild disseminated intravascular coagulation.
  • The patient developed acute kidney injury requiring continuous veno-venous hemodiafiltration and prolonged intensive care unit admission.

Findings:

  • Emergent delivery was necessitated due to the severity of HELLP syndrome.
  • Comprehensive supportive care led to the normalization of all laboratory derangements, including renal function, within 4 weeks post-delivery.

Implications:

  • This case underscores the critical role of intensive supportive management in severe HELLP syndrome, including cases with acute kidney injury.
  • Accurate diagnosis and timely intervention are crucial, distinguishing HELLP syndrome from its mimics to ensure appropriate patient care and management.

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