HELLP Syndrome

HELLP stands for haemolysis, elevated liver enzymes, and low platelets. In Canadian practice, it is understood as a severe end-organ manifestation of the preeclampsia disease process, not as a completely separate disease. It reflects widespread endothelial injury: platelets are consumed in small-vessel thrombi, red cells fragment as they pass through narrowed fibrin-lined vessels, and injury around the hepatic sinusoids causes hepatocellular necrosis and leakage of transaminases. Distension of the liver capsule produces the characteristic upper-abdominal pain. HELLP most often appears between approximately 28 and 37 weeks, but it can begin after birth. About one-third of cases are recognised postpartum, commonly within 48 hours to 7 days after delivery. Proteinuria is not required, and blood pressure may be normal or only mildly elevated in up to 12–20% of patients. A patient with new epigastric or right-upper-quadrant pain, nausea, vomiting, or unexplained malaise therefore deserves urgent assessment even when the blood pressure does not look alarming. The danger is not confined to the laboratory values. The syndrome can progress to eclampsia, disseminated intravascular coagulation, acute kidney injury, pulmonary oedema, placental abruption, hepatic...