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Hellp Syndrome

Hellp Syndrome is a topic covered in the 5-Minute Emergency Consult.

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  • HELLP syndrome: Hemolysis Elevated Liver enzymes, Low Platelets
  • Continuum with severe preeclampsia as most patients will be hypertensive
  • Liver involvement is hallmark:
    • Other organs may be involved (e.g., brain, kidneys, lungs)
  • HELLP syndrome divided into 3 groups, representing severity of the disease; severity is directly related to the platelet count:
    • Class 1: Most severe form; platelet nadir <50,000 platelets/μL
    • Class 2: Less severe; platelet nadir between 50,000 and 100,000 platelets/μL
    • Class 3: Least severe; platelet nadir between 100,000 and 150,000 platelets/μL
  • Most maternal deaths occur with class 1
  • Increased mortality rate is associated with hepatic hemorrhage or CNS or vascular insult to the cardiopulmonary or renal systems
  • Incidence: 0.2% of all pregnancies
  • 12–18% have normal BP
  • Occurs in 20% of pregnancies with severe preeclampsia or eclampsia
  • At diagnosis:
    • 52% preterm
    • 18% term
    • 32% postpartum

Risk Factors

Frequently white, multiparous, older
Pediatric Considerations
Infant mortality is greater in women with HELLP


  • Unclear, but vasospasm is the basis:
    • Fetal-placental debris is released into maternal circulation, causing systemic inflammatory response
    • Vascular constriction causes resistance to blood flow and HTN
    • Vasospasm probably damages vessels directly
    • Angiotensin II causes endothelial cells to contract
    • Endothelial cell is damaged and interendothelial cell leaks are the result
  • Small-vessel leaks:
    • Platelets and fibrinogen get deposited in the subendothelium
    • Fibrin deposition develops in severe cases
  • Vascular changes and local tissue hypoxia lead to hemorrhage, necrosis, and end-organ damage

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Rosen, Peter, et al., editors. "Hellp Syndrome." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307300/all/Hellp_Syndrome.
Hellp Syndrome. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307300/all/Hellp_Syndrome. Accessed April 23, 2019.
Hellp Syndrome. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307300/all/Hellp_Syndrome
Hellp Syndrome [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 23]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307300/all/Hellp_Syndrome.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Hellp Syndrome ID - 307300 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307300/all/Hellp_Syndrome PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -