Medicina (Kaunas) 2006; 42 (9): 695-702

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Hemolysis, elevated liver enzymes, and low platelet count syndrome

Dalia Adukauskienė, Venta Vizgirdaitė1, Kęstutis Rimaitis2, Asta Aliuškevičienė2

Clinic of Intensive Care, Kaunas University of Medicine, 1Kaunas University of Medicine, 2Clinic of Anesthesiology, Kaunas University of Medicine, Lithuania

Key words: hemolysis, elevated liver enzymes, and low platelet count syndrome, pregnancy pathology, preeclampsia.

Summary. HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome is a severe, life-threatening pregnancy pathology, which occurs in 0.2–0.8% of all pregnancies, and approximately 10% (2–20%) of pregnancies are complicated with severe preeclampsia. This syndrome usually develops in the third trimester of pregnancy in preeclamptic patients, sometimes it occurs in the second trimester of pregnancy, and very rarely HELLP syndrome may develop within 48–72 hours after delivery. Diagnosis is complicated as there are no specific clinical signs, therefore, this syndrome may be confused with other pathologies like acute fatty liver of pregnancy, idiopathic thrombocytopenia, hemolytic uremic syndrome, appendicitis, and etc. The patients with HELLP syndrome should be treated in the tertiary care hospital, where appropriate diagnostics and multidisciplinary help for mother and fetus can be assured. When the syndrome was described for the first time, L. Weinstein recommended prompt delivery as the only possible treatment. Current studies show that conservative treatment of patients with HELLP syndrome is safe, without an increase in morbidity and mortality. That is why now many authors agree that treatment approach should be based on the estimated gestational age and the condition of the mother and fetus.

Correspondence to V. Vizgirdaitė, Kaunas University of Medicine, A. Mickevičiaus 9, 44307 Kaunas, Lithuania. E-mail:

Received 27 February 2006, accepted 28 April 2006