HELLP - Hemolysis with a microangiopathic blood smear, Elevated Liver enzymes, and a Low Platelet count

• Severe pre-eclamptic liver dysfunction
• Hemolysis (LDH >600 U/L, peripheral smear [schistocytes], and indirect hyperbilirubinemia)
• Elevated liver enzymes (AST ≥70 IU/L, T-bili ≥1.2 mg/dL)
• Low platelets (≤100,000 cells/microL)

Presentation

• With or without hypertension
• Abdominal pain, N/V, with or without jaundice
• Usually in third trimester

Complications

• DIC
• Abruptio placentae
• Acute renal failure
• Pulm edema
• Liver hematoma or infarction
  
• Retinal detachment

Testing

• CBC
• LFT
• Urine protein and creatinine
• Peripheral smear

Treatment

• Anti-HTN meds - labetalol, hydralazine, nifedipine, nitroprusside
• Magnesium sulfate - seizures
• Delivery
• Platelet transfusion