Hellp Syndrome

1.Introduction This is a life threatening disorder thought to be a variant of pre-eclampsia. The two conditions occur during the later stages of pregnancy or after childbirth. 2. Hellp means: Haemolytic Anaemia Elevated Liver Enzymes and Low Platelet Count. 3. Methods Hellp is associated with gestational hypertension and in patients who have pre-eclampsia elevated blood pressure and proteinuria. It is thought to be a malignant clonal stem cell disorder! The patients get headaches, blurred vision, malaise, nausea and vomiting abdominal pain and paraesthesias. Generalized oedema may occur. The liver capsule may rupture with a resultant haematoma. Seizures and coma lead to full blown eclampsia. DIC (Disseminated Intravascular Coagulation) is seen in 20% of cases 84 % of cases go into renal failure. Patients with Hellp may be misdiagnosed increasing the risk of liver failure and morbidity [1]. 4. Results In a patient with Hellp syndrome blood tests should include; full blood count, liver enzymes; urea and electrolytes and creatinine and prothrombin index /international normalized ratio, partial thromboplastin time and fibrin degradation products Lactate dehydrogenase is a marker of haemolysis and albuminuria may be present. D-Dimers are a useful test in the disorder. The platelet count may be low, e.g. < 50000. The coagulation system is thought to be the problem. Fibrin crosslinks the vessels. A microangiopathic haemolytic anaemia results and erythrocytes are destroyed. Thrombocytopaenia results and hepatic ischaemia leads to periportal necrosis. 5. Conclusion The DIC (Disseminated Intravascular Coagulopathy) leads to paradoxical haemorrhage. Seizures should be treated as for eclampsia and fresh frozen plasma, steroids and anti-hypertensives must be given. Fluids (preferably Ringer’s lactate) should be given at the required rate Hepatic haemorrhage must be treated by embolization. The incidence of Hellp is 0.2-0,6% i.e.10 to 20% of pregnancies. With treatment maternal mortality is 1%. Complications include renal failure, subcapsular hepatic haematoma and retinal detachment. Hellp syndrome was discovered in 1982 by Dr. Louis Weinstein [2].