History
HELLP syndrome typically occurs between 27 weeks’ gestation and delivery in women with a mean age of 25 years.
A complete review of systems may reveal malaise, nausea, vomiting, weight gain, and various other nonspecific symptoms.
A wide range of symptoms, none of which are diagnostic, may be present in persons with HELLP syndrome. For instance, nausea, vomiting, and epigastric and right upper quadrant pain has been reported in 30%-90% [20, 30, 31] of patients, headache in 33%-68%, [32, 30] visual changes in 10%-20%, [33] and jaundice in 5%. [24]
In a series by Sibai et al, most patients with HELLP syndrome presented preterm with complaints of epigastric or right upper quadrant pain and nonspecific viral syndrome types of symptoms. [20] In earlier studies by Weinstein, nausea, vomiting, and epigastric pain were found to be the most common symptoms in patients with HELLP symptoms. [34, 3]
Common history findings are as follows:
-
Malaise
-
Nausea and vomiting
-
Edema with secondary weight gain
-
Epigastric or right upper quadrant pain
-
Dyspnea (if pulmonary edema present)
Physical Examination
A complete physical examination may reveal signs of dehydration, including dry mucous membranes, sunken eyes, weakness, and imbalance secondary to dizziness from excessive vomiting. Vital signs may reveal tachycardia, tachypnea, and hypertension.
Patients with HELLP syndrome show various signs and symptoms, many of which are synonymous with preeclampsia. Proteinuria is shown to be present in 86%-100% of patients and hypertension in 80%. [24] However, it should be noted that 15% of patients do not present with either. [20, 18, 33]
In addition, 55%-67% of patients present with nondependent edema, which can be periorbital or in the upper and lower extremities. [2] Right upper quadrant tenderness is found in 65%-90% of patients, while jaundice is evident in 5% of patients. [24] A lung examination may reveal crackles if pulmonary edema is present.
Vital signs may include the following:
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Hypertension
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Tachycardia
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Tachypnea
Generalized findings may include the following:
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Fatigue or weakness
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Distress due to pain
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Jaundice
Head, ears, eyes, nose and throat (HEENT) findings may include the following:
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Signs of dehydration including sunken eyes
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Edema leading to puffy eyes
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Dry mucous membranes
Pulmonary findings may include crackles secondary to noncardiogenic pulmonary edema.
Abdominal findings may include right upper quadrant to epigastric tenderness.
Extremities findings may include edema.
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Overview of the Management of HELLP Syndrome
Tables
|
Class 1 (Severe) |
Class 2 (Moderate) |
Class 3 (Mild) |
Platelets |
≤50,000/µL |
50,000-100,000/µL |
100,000-150,000/µL |
AST or ALT |
≥70 IU/L |
≥70 IU/L |
≥40 IU/L |
LDH |
≥600 IU/L |
≥600 IU/L |
≥600 IU/L |
Incidence of bleeding |
13% |
8% |
No increased risk |
Laboratory Test |
Possible Result |
Cause |
Recovery to Baseline (in Number of Hours or Days Postpartum) |
Haptoglobin |
↓ |
Hemolysis |
24-30 hours |
LDH |
↑ |
Hemolysis or liver dysfunction |
3-5 days |
AST or ALT |
↑ |
Liver dysfunction |
3-5 days |
Bilirubin |
↑ |
Hemolysis |
- |
Platelets (CBC) |
↓ |
Consumption |
6-11 days |
Hemoglobin/Hematocrit (CBC) |
↓ |
Hemolysis |
- |
PT |
Normal |
|
|
PTT |
↑ |
Liver dysfunction |
- |
D-dimer |
↑ |
Increased coagulation and secondary fibrinolysis |
- |
Fibrinogen |
↓ |
- |
