HELLP
HELLP Syndrome (Severe Preeclampsia Variant)
An obstetric emergency — delivery is often the cure.
Memory aids matter when a pregnant patient walks in with right upper quadrant pain and the differential includes biliary disease, gastritis, and an obstetric emergency — and only one of those gets a same-day delivery. HELLP — Hemolysis (schistocytes, low haptoglobin, elevated LDH), Elevated Liver enzymes, Low Platelets under 100k — is a severe variant of preeclampsia that can occur with or without hypertension and proteinuria. Maternal mortality runs around 1%; the only definitive treatment is delivery. AANP exam questions test recognizing HELLP in a vignette where blood pressure is borderline and the chief complaint is RUQ pain or malaise, and knowing that escalation, not observation, is the answer.
- HHemolysisMicroangiopathic — schistocytes on smear; elevated LDH; low haptoglobin.
- ELElevated Liver enzymesAST/ALT >2× ULN; RUQ or epigastric pain.
- LPLow Platelets<100,000/µL.
Clinical Context
Severe variant of preeclampsia that can occur with or without classic hypertension and proteinuria. Presents in the third trimester or postpartum with RUQ/epigastric pain, nausea, headache, and thrombocytopenia. Severity ranges from mild to DIC + hepatic rupture.
Definitive treatment is delivery regardless of gestational age if severe or fetal distress is present. Stabilize with magnesium sulfate (seizure prophylaxis), antihypertensives (labetalol, hydralazine), and corticosteroids if <34 weeks for fetal lung maturity. AANP red flag: third-trimester woman with RUQ pain and even mildly elevated BP — don't miss HELLP masquerading as cholecystitis.
Related Mnemonics
Sources
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