Syndrome of hemolysis, elevated liver enzymes, and low platelet count: A severe consequence of hypertension in pregnancy

  • Louis Weinstein
    Department of Obstetrics and Gynecology, University of Arizona Health Sciences Center, Tucson, Arizona 85724.
    From the Department of Obstetrics and Gynecology, University of Arizona, Tucson, Arizona
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      Data are presented to define a unique group of preeclamptic/eclamptic patients with the finding of hemolysis (H), elevated liver enzymes (EL), and a low platelet count (LP). This entity has been termed the HELLP syndrome and may occur when the usual clinical findings to diagnose severe preeclampsia are absent. Often the patient is given a nonobstetric diagnosis and treatment is withheld or modified. The possible pathophysiology of this syndrome, the management of the patient, and the maternal and neonatal outcomes are presented. Recognition of the clinical and laboratory findings of the HELLP syndrome is important if early, aggressive therapy is to be initiated to prevent maternal and neonatal death. The practicing obstetrician must be knowledgeable about this severe consequence of hypertension in pregnancy.
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        • Pritchard J.A.
        • Weisman R.
        • Ratnoff O.D.
        • Vosburgh G.J.
        Intravascular hemolysis, thrombocytopenia and other hematologic abnormalities associated with severe toxemia of pregnancy.
        N. Engl. J. Med. 1954; 250: 89
        • McKay D.G.
        Hematologic evidence of disseminated intravascular coagulation in eclampsia.
        Obstet. Gynecol. Surv. 1972; 27: 399
        • Pritchard J.A.
        • Cunningham F.G.
        • Mason R.A.
        Coagulation changes in eclampsia: their frequency and pathogenesis.
        Am. J. Obstet. Gynecol. 1976; 124: 855
        • Kitzmiller J.L.
        • Lang J.E.
        • Yelenosky P.F.
        • Lucas W.E.
        Hematologic assays in pre-eclampsia.
        Am. J. Obstet. Gynecol. 1974; 118: 362
        • Goodlin R.C.
        Severe pre-eclampsia: another great imitator.
        Am. J. Obstet. Gynecol. 1976; 125: 747
        • Goodlin R.C.
        • Cotton D.B.
        • Haesslein H.C.
        Severe edema–proteinuria–hypertension gestosis.
        Am. J. Obstet. Gynecol. 1978; 132: 595
        • Killam A.P.
        • Dillard S.H.
        • Patton R.C.
        • Pederson P.R.
        Pregnancy-induced hypertension complicated by acute liver disease and disseminated intravascular coagulation.
        Am. J. Obstet. Gynecol. 1975; 123: 823
        • Redman C.W.G.
        • Bonnar J.
        • Beilin L.
        Early platelet consumption in preeclampsia.
        Br. Med. J. 1978; 1: 467
        • Brunner H.R.
        • Garvos H.
        Vascular damage in hypertension.
        Hosp. Pract. 1975; 10: 97
        • Arias F.
        • Mancilla-Jimenez R.M.
        Hepatic fibrinogen deposits in preeclampsia: immunofluorescent evidence.
        N. Engl. J. Med. 1976; 295: 578
        • Brain M.C.
        • Dacie J.V.
        • Hourihane D.O.B.
        Microangiopathic hemolytic anemia: the possible role of vascular lesions in pathogenesis.
        Br. J. Haematol. 1962; 8: 358
        • Kleikner H.B.
        • Giles H.R.
        • Corrigan J.J.
        The association of maternal and neonatal thrombocytopenia in high-risk pregnancies.
        Am. J. Obstet. Gynecol. 1977; 128: 235
        • Widerlov E.
        • Karlman I.
        • Storsater J.
        Hydralazine-induced neonatal thrombocytopenia.
        N. Engl. J. Med. 1980; 303: 1235