D. HELLP syndrome – Explanation

HELLP syndrome
This is a serious complication regarded by most as a variant of severe pre-
eclampsiawhich manifests with haemolysis (H), elevated liver enzymes (EL), and low
platelets(LP).

Liver enzymes usually increase and platelets decrease before haemolysis occurs.

The syndrome is usually self-limiting, but permanent liver or renal damage may occur.

Note that eclampsia may co-exist.

Signs and Symptoms:
• Epigastric or RUQ pain and tenderness
• Nausea and vomiting
• Urine is ‘tea-coloured’ due to haemolysis.
• Increased BP and other features of pre-eclamsia

Management
• Delivery
• Supportive and as for eclampsia (magnesium sulfate (MgSO 4 ) is indicated)
•Although platelet levels may be very low, platelet infusions are only required if
bleeding, or for surgery and <40

DIFFERENTIATING AFLP FROM HELLP
Acute fatty liver of pregnancy vs Haemolysis, Elevated Liver enzymes, Low Platelets
syndrome.

It is unlikely that you would need to know all the different features of HELLP and AFLP
for the level of the PLAB exam as even senior medical and obstetric teams often have
difficulty telling them apart in a clinical setting, however this table is inserted for those
who would like to understand how to differentiate them for your own clinical knowledge.