Diagnosis and Management of HELLP Syndrome

Diagnostic Criteria

The American College of Obstetricians and Gynecologists recommends that the diagnosis of HELLP syndrome be based on the presence of hemolysis, elevated liver enzymes, and low platelet count, with a peripheral blood smear showing schistocytes being a critical diagnostic step 1.
The presence of anemia, elevated liver enzymes (AST 135 U/L, FA 897 U/L), and low platelet count (88,000/mm³) in a pregnant woman at 31 weeks of gestation is highly suggestive of HELLP syndrome, according to the American College of Gastroenterology 2.

The American College of Gastroenterology states that the syndrome of hemolytic uremic syndrome, although presenting with microangiopathic hemolytic anemia, does not explain the marked elevation of liver enzymes or the obstetric context of the third trimester 2.
The American Heart Association notes that antiphospholipid syndrome does not present with the characteristic triad of HELLP and would require positive specific antibodies 2.

The American College of Obstetricians and Gynecologists recommends that the management of HELLP syndrome include urgent delivery once the patient is stabilized, with priorities including maternal stabilization, invasive monitoring, seizure prophylaxis, and urgent delivery 1.
The British Society of Haematology suggests that the use of fresh frozen plasma to correct coagulopathy and platelet transfusion if <50,000/mm³ before cesarean section is crucial in the management of HELLP syndrome 1.

The British Journal of Anaesthesia recommends that hypoalbuminemia from hepatic dysfunction, with albumin levels potentially dropping, should be considered in the management of HELLP syndrome 3, 4
The American College of Obstetricians and Gynecologists implies that central venous catheter placement is necessary to guide fluid management in patients with HELLP syndrome, as they are paradoxically hypovolemic despite ascites 3, 4, 5
Fresh frozen plasma administration is recommended to correct coagulopathy before any surgical intervention, according to the British Journal of Anaesthesia 3, 4
Platelet transfusion is indicated if the count is <50,000/mm³ before cesarean section, as suggested by Praxis Medical Insights 6, 5
Prompt delivery is indicated once maternal coagulopathy is corrected and severe hypertension controlled, with the understanding that HELLP syndrome only resolves after delivery, as stated by Praxis Medical Insights 6, 5
Regional anesthesia (epidural/spinal) should not be used with elevated INR or platelets <100,000/mm³ due to the risk of epidural hematoma, as warned by Praxis Medical Insights 6, 5
Vigilance for hepatic complications, including subcapsular hematoma or rupture, is necessary, especially with severe thrombocytopenia and persistent right upper quadrant pain, as advised by Praxis Medical Insights 5, 7