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

To view the entire topic, please or purchase a subscription.

Emergency Central is a collection of disease, drug, and test information including 5-Minute Emergency Medicine Consult, Davis’s Drug, McGraw-Hill Medical’s Diagnosaurus®, Pocket Guide to Diagnostic Tests, and MEDLINE Journals created for emergency medicine professionals. Explore these free sample topics:

Emergency Central

-- The first section of this topic is shown below --

Basics

Description

  • 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

Etiology

  • 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

-- To view the remaining sections of this topic, please or purchase a subscription --

Citation

* When formatting your citation, note that all book, journal, and database titles should be italicized* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Hellp Syndrome ID - 307300 Y1 - 2016 PB - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307300/all/Hellp_Syndrome ER -