Contemporary Diagnostic Approach to HELLP Syndrome : A Clinical Review

Abstract

HELLP syndrome (haemolysis, elevated liver enzymes, and low platelets) is a clinical status which calls for an urgent therapy, mainly focused to a prompt parturition. The classical initial symptoms are epigastric or right upper quadrant pain, nausea and vomiting. The differential diagnostic problems of HELLP syndrome arise in relation to the mimicry symptomatic upper abdominal pain which can imitate : a) gastroenterologic diseases (e.g. cholelithiasis, appendicitis) ; b) liver diseases, such as viral hepatitis (elevated liver enzymes combined with hyperbilirubinemia) ; and c) thrombotic microangiopathies (due to thrombocytopenia in combination with haemolytic anaemia, neurological symptoms and renal failure). Regarding the common symptoms : thrombocytopenia, haemolysis, as well as signs of pre-eclampsia with or without renal failure the differentiation from various autoimmune diseases also can be difficult in special cases. Rare first manifestations and serious simultaneous diseases which can overlap the typical signs of HELLP syndrome show the full variety of HELLP syndrome. The delay of interdisciplinary approach in achieving a clear final diagnosis causes serious consequences, which could lead to deleterious effects on the mother and the fetus. Therefore, all pregnant women with upper abdominal pain, irrespective of symptoms of pre-eclampsia, should be considered to have HELLP syndrome. This requires an immediate laboratory evaluation and, in cases of doubt, an interdisciplinary consultation.