HELLP syndrome: A Case Report

Abstract

          HELLP syndrome, the eponym for hemolysis, elevated liver enzymes and low platelet level, consists of the microangiopathic hemolytic anemia, elevated liver enzymes: AST, ALT, and the low platelet count. It is one of the rare but serious complications of pregnancy which may result in both maternal and fetal morbidity and mortality. In Thailand, it has been occasionally reported. Herein, we report the case of HELLP syndrome occurring in a 32-year old Thai woman.She complained of acute abdominal pain, blurred vision and false labor painfor 1 day at the gestational age of 24 weeks, P3-0-0-2, without fever. The investigations confirmed the diagnosis of HELLP syndrome including Hct 29.3 %, platelet 36,000/mm³, AST 110 U/L, ALT 98 U/L, the polychromasia, schistocytes in the peripheral blood, total bilirubin of 1.4 mg% and LDH 1,200 U/L with severe hypertension and proteinuria. Dead fetus in utero was accidentally found. She had been irregularly treated for hypertensionbefore getting this fourth pregnancy. After her severe high blood pressure was well controlled with the intravenous nicardipine infusion and the packed red blood cell and the platelet concentrate were transfused, she developed spontaneous labor pain and delivered the male stillbirth baby vaginally, breech presentation, birth weight of 678 gram without excessive intrapartum bleeding or postpartum hemorrhage. The liver enzymes and platelet count became normal within 5 days after delivery but she still needed continuouslyoral antihypertensive therapy. Death in utero in cases of HELLP syndrome as in our patient was presumably associated with the gestational age when it was incident more than the degree of severity of the syndrome.