A few weeks back we talked about preeclampsia, and one of the complications of that condition is HELLP syndrome. This is a life-threatening condition that occurs during the later stages of pregnancy or even after giving birth. With a mortality rate as high as 30%, it is characterized by dysfunction of the blood and the liver:

  • H: Hemolysis
  • EL: Elevated liver enzymes
  • LP: Low platelets

HELLP syndrome is classified according to the severity of the thrombocytopenia. Class I is considered “severe” and is present with a platelet count under 50,000/mm3. Class II is “moderate” and is present with a platelet count between 50,000 and 100,000/mm3. Class III is considered “mild” and is present when platelets are between 100,000 and 150,000/mm3. 

What are the signs & symptoms of HELLP syndrome?

  • Bleeding, which is due to the low platelets; bleeding can occur in the liver as well
  • Abdominal pain, especially in the right upper quadrant, which is due to the liver involvement
  • Shoulder pain (this is “referred pain” from the distended liver)
  • Neurological abnormalities: vision changes, headache, seizure; these signs can be due to hypertension, cerebral edema or even cerebral hemorrhage due to the low platelets
  • Edema
  • Difficulty breathing due to pulmonary edema
  • Nausea/vomiting
  • Elevated blood pressure
  • Protein in the urine

What tests are conducted?

  • CT scan can show bleeding or distention in the liver
  • Platelet count (CBC)
  • Liver enzymes (AST, ALT)
  • Urinalysis to assess for protein in the urine
  • Blood pressure
  • Ultrasound to assess baby
  • Fetal heart rate monitoring

Complications of HELLP syndrome

HELLP syndrome can be fatal if left untreated, and even so, still has a high mortality rate of around 30%. 

DIC (disseminated intravascular coagulation) is a blood clotting disorder that can occur with HELLP syndrome. In DIC, prothrombin time, activated partial thromboplastin time and fibrinogen levels are all increased. Patients with DIC have small blood clots developing throughout the entire bloodstream, which block small blood vessels. Eventually, all the platelets and clotting factors are depleted, which leads to excessive and uncontrolled bleeding. 

Liver failure, bleeding or even rupture can occur. 

Cerebral hemorrhage can occur from the thrombocytopenia, especially in the presence of hypertension. 

Other complications include pulmonary edema, kidney failure and placental abruption.

And, of course, we can’t forget about the complications associated with premature birth if an emergent delivery is necessary.

How is HELLP syndrome treated?

In many cases, imminent delivery will be necessary and typically resolves the syndrome. Mom may need blood products such as platelets, plasma and RBCs to combat the bleeding and thrombocytopenia. Magnesium is given to prevent seizures, just as it is in preeclampsia/eclampsia. Medications to treat hypertension may be utilized, and mom may also receive a corticosteroid to help the baby’s lungs mature and prevent respiratory complications that are common in premature infants.

Get this on audio on the Straight A Nursing podcast, episode 79.

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References

Laney. (2019, January 3). About HELLP Syndrome. Retrieved November 10, 2019, from Preeclampsia Foundation Official Site website: https://www.preeclampsia.org/health-information/hellp-syndrome

March of Dimes. (n.d.). HELLP syndrome. Retrieved November 10, 2019, from https://www.marchofdimes.org/complications/hellp-syndrome.aspx