HELLP Syndrome

What is HELLP Syndrome?

HELLP syndrome is a rare, however serious complication that affects pregnant women. It is a variant of preeclampsia. HELLP syndrome stands for the following signs and symptoms -

• H - Hemolysis (breakdown of red blood cell)
• EL- Elevated liver enzyme
• LP- Low platelet count

What are the Causes of HELLP Syndrome?

The condition affects about 0.5-0.9% pregnant women. It occurs at a later stage of pregnancy or may be even after childbirth.

The exact cause of the syndrome is not known. It is considered as a symptom of the underlying disorder, and not a disease on its own. It is a complication of pre-eclampsia, a disorder in pregnant women marked by high blood pressure and presence of protein in the urine (proteinuria).

Other risk factors include:

• Obesity
• Poor diet
• Diabetes
• Age of the pregnant women (more than 35 years)
• Multiple pregnancies
• History of preeclampsia

What are the Signs and Symptoms of HELLP Syndrome?

A series of symptoms make up this syndrome that are as follows:

• Fatigue and malaise
• Fluid retention
• Severe headache
• Excess weight gain
• Nausea and vomiting that get worse with time
• Pain in the abdomen
• Paresthesia (pins and needles sensation in the extremities)
• Visual disturbances
• Swelling, especially in the legs
• Nose bleed
• Seizures

How do you Diagnose HELLP Syndrome?

Symptoms related to HELLP syndrome often mimic other diseases or complications. Physical examination followed by confirmatory blood tests and urine test are done to diagnose HELLP syndrome.

• During the physical examination, the doctor will look for abdominal tenderness, whether the liver is enlarged, or any excess swelling, especially in the legs.
• Blood tests -
• CBC (complete blood count) provides information regarding red blood cells, white blood cells, and platelet count. Hemolysis, the breakdown of red blood cells, is a characteristic feature of HELLP syndrome. Abnormal peripheral smear with low platelet count is indicative of HELLP syndrome.
• LDH (lactate dehydrogenase) is an enzyme that helps body tissues to produce energy. LDH is present in almost all body tissues. LDH level rises if there is any damage to the cell.
• LFT (liver function test) is a series of blood tests done to detect the presence of liver disease. Liver enzymes are high due to liver injury from the excessive breakdown of red blood cells.

• Urine test determines the presence of excessive protein along with increased level of uric acid.
• Blood pressure if high signifies HELLP syndrome.
• MRI or CT Scan is recommended to check for any internal bleeding, especially in the liver.
• Fetal monitoring tests include sonograms, non-stress tests, and fetal movement evaluation to check for the baby's health.

What is the Treatment for HELLP Syndrome?

• The delivery of a baby is a definitive treatment. This will prevent further complications. Most women stop experiencing symptoms after 4-5 days of their delivery. Delivery should be considered after the completion of 34 weeks of pregnancy.
• Corticosteroids are prescribed, which help both the baby and the mother. If delivery can be postponed, corticosteroids should be given to promote fetal lung maturation.
• During pregnancy, women with low platelet count may need blood. Hence, blood transfusion is done. Transfusion of red cells, platelets, fresh frozen plasma may be required as indicated.
• Medications to control blood pressure need to be taken. Antihypertensive medicines like Labetalol and nifedipine are prescribed.

• Magnesium sulfate is prescribed as a precautionary medicine to prevent episodes of seizures or convulsions.

What is the Prognosis of HELLP Syndrome?

Early diagnosis is the key to reduced morbidity and mortality. If the condition is treated early, most women recover completely.

If HELLP syndrome is left untreated, about 25% of the women develop serious complications, such as blood clots, placental abruption, renal failure, and liver damage.

Health tips

The condition cannot be completely prevented. However, if a woman is diagnosed with preeclampsia, precautions can be taken to lower the risk of HELLP syndrome.

• Maintain a healthy life style that includes regular exercise, weight appropriate for your height
• Have a balanced diet consisting of fresh vegetables, fruits, and protein.

References:

1. The HELLP syndrome: Clinical issues and management. A Review - (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2654858/)
2. Pregnancy Complications - HELLP Syndrome - (http://americanpregnancy.org/pregnancy-complications/hellp-syndrome/)
3. HELLP Syndrome - (https://familydoctor.org/condition/hellp-syndrome/)
4. What is HELLP syndrome? - (https://medlineplus.gov/ency/article/000890.htm)
5. Know About HELLP Syndrome? - (https://www.preeclampsia.org/health-information/hellp-syndrome)

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