HELLP Syndrome
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HELLP syndrome is serious complication of pre-eclampsia or eclampsia. HELLP syndrome is stands for Hemolysis, Elevated Liver enzyme levels and a Low Platelet count characterized by bleeding diathesis, liver problems and increased blood pressure. HELLP syndrome can threatens both mother and fetus.
The exact cause of HELLP syndrome is unknown but thought to be that it is due to activation of the coagulation cascade this leads to a microangiopathic hemolytic anemia. In HELLP syndrome not only RBC is consumed but also platelet consumed. Due to blood clot in small arteries, blood supply to liver cells is decreased and suffers ischemia, leading to periportal ischemia. HELLP syndrome leads to a variant form of disseminated intravascular coagulation (DIC), leading to paradoxical bleeding, which can make emergency surgery a serious challenge.
What are the symptoms of HELLP syndrome?
- High blood pressure during pregnancy
- Pain or tenderness in the upper right side of the stomach
- Nausea or vomiting
- Headache
- Blurred vision
- seizure
- abnormal bleeding or clot formation due to DIC
- oliguria or anuria due acute renal failure
- Shortness of breath due to pulmonary embolism
- coma
How HELLP syndrome diagnosed?
HELLP syndrome is diagnosed by patient’s history, physical examination and lab tests.
Lab tests includes:
- Full blood count shows anemia and decreased platelets count.
- Liver function test shows elevated levels of LDH, asparate aminotransferase (AST) ,alanine aminotransferase (ALAT) , glutathione S-transferase-a1 (?-GST or GST-a1) and bilirubin .
How to managed HELLP syndrome ?
Patient with HELLP syndrome need ICU setup. Several treatment strategies have been considered to be beneficial in stabilization of the disease but the only effective treatment is prompt delivery of the baby. Patient’s presents with seizure is managed with giving intravenous magnesium sulfate or diazepam. DIC is managed with fresh frozen plasma or fresh blood transfusion. In mild cases, corticosteroids and antihypertensive (hydralazine, and nifedipine) may be sufficient. One of the latest research shows that administration of postpartum dexamethasone resulted in the rapid resolution of the HELLP syndrome as measured by increasing platelet counts and decreasing LDH, AST, and ALT levels. Recurrence in the abnormalities in platelet counts and liver functions was not noted after completion of therapy in patients.
What is the prognosis of HELLP syndrome?
If HELLP syndrome is not treated properly up to 25% of women develop serious complication and a small number of women may die.
Filed Under: Female Health
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