HELLP syndrome

The HELLP syndrome is a pregnancy related condition and is an abbreviation for

• haemolysis
• elevated liver enzymes and 
• low platelets

It is considered a severe and life threatening form of pre-eclampsia.

Epidemiology

The estimated incidence is at ~ 0.17 - 0.85 of live births ⁹. The condition often occurs in the 3^rd trimeter of pregnancy (and occasionally post partum). It tends to present in young primagravid women. 

Clinical presentation

Presentation can be variable and can include malaise , epigastric / right upper-quadrant pain, and nausea / vomiting. Some may have non-specific viral-syndrome-like symptoms. Hypertension and proteinuria (classic symptoms of pre eclampsia) may be absent or slight ⁷. 

Pathology

On liver histology, there is may a combination of deposited fibrin, haemorrhage and hepatocellular necrosis surrounding portal areas ⁶. 

Radiographic features

CT abdomen

The place of CT is mainly to assess for complications.

When considering a CT scan the radiologist needs to discuss with the obstetrician regarding radiation risk to fetus from radiation versus clinical suspicion of a complications in order to make a rational judgement. The CT scan may show hepatic complications such as rupture, sub capsular haematoma or hepatic infarction.

Complications

• disseminated intravascular coagulation : reported to occur in ~ 20 – 40 % of patients ⁵
• hepatic infarction
• hepatic haematoma
• hepatic rupture
• placental abruption

Treatment and prognosis

Management is often supportive. Patients with hepatic rupture + / - intraperitoneal bleeding require immediate surgery or selective hepatic arterial embolisation. 

Etymology

The condition was originally described Pritchard et al in 1954 ³ with the acronym later coined  by L Weinstein in 1982 ⁴.