HELLP syndrome: a diagnostic conundrum with severe complications

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.