HELLP syndrome - overview
HELLP (Haemolysis, Elevated Liver enzymes, Low Platelets) is a life‑threatening variant of pre‑eclampsia. It may present with typical pre‑eclamptic features but can be atypical with only mild or absent hypertension/proteinuria.
HELLP is an obstetric emergency that usually requires early multidisciplinary input (obstetrics, anaesthetics, critical care, neonatology) and often definitive treatment by delivery. Early recognition in the ED, urgent laboratory assessment and prompt escalation reduce maternal and fetal morbidity and mortality (NICE NG133).
Pathophysiology - why it matters
HELLP reflects systemic endothelial dysfunction and microvascular injury from abnormal placentation. Microangiopathic haemolysis and platelet consumption produce thrombocytopenia and schistocytes. Hepatic ischemia and necrosis raise transaminases and can cause subcapsular haematoma or rupture.
The resulting coagulopathy and vascular leak increase the risks of bleeding, multiorgan failure and pulmonary oedema - features that determine acute ED management.
Clinical presentation Common features
- New or worsening hypertension, though blood pressure may be only mildly raised or even normal.
- Severe epigastric or right upper‑quadrant pain or tenderness (classical presentation).
- Nausea, vomiting, malaise, anorexia.
- Signs of haemolysis: pallor, jaundice, dark urine.
- Bleeding, petechiae or mucosal oozing from thrombocytopenia.
- Oliguria or rising creatinine.
- Neurological symptoms: severe headache, visual disturbance, confusion (overlaps with pre‑eclampsia/eclampsia).