From the Guidelines
HELLP syndrome is diagnosed through specific laboratory findings that include hemolysis, elevated liver enzymes, and low platelet count, with diagnostic criteria typically involving a platelet count below 100,000/mm³, evidence of hemolysis, and elevated liver enzymes. The diagnostic criteria for HELLP syndrome involve a combination of laboratory findings, including:
- A platelet count below 100,000/mm³
- Evidence of hemolysis, such as elevated lactate dehydrogenase (LDH) levels above 600 IU/L, abnormal peripheral blood smear, or increased bilirubin above 1.2 mg/dL
- Elevated liver enzymes, such as aspartate aminotransferase (AST) and alanine aminotransferase (ALT) typically above 70 IU/L, as noted in the study by 1 These laboratory abnormalities reflect the underlying pathophysiology of HELLP syndrome, which involves microangiopathic hemolytic anemia, hepatocellular damage, and thrombocytopenia. The condition is a severe complication of preeclampsia, though it can occur without hypertension or proteinuria in about 15-20% of cases. Early recognition of these laboratory abnormalities is crucial as HELLP syndrome can rapidly progress to serious complications, including disseminated intravascular coagulation, placental abruption, acute renal failure, pulmonary edema, and hepatic rupture. The definitive treatment is delivery of the fetus, regardless of gestational age, though temporary supportive measures may be implemented to stabilize the mother and allow for corticosteroid administration if the pregnancy is less than 34 weeks, as recommended by 1. Some key laboratory findings and management strategies for HELLP syndrome include:
- Platelet transfusion if the platelet count is less than 50,000/mm³, as noted in the study by 1
- Administration of fresh frozen plasma and platelets to correct hypovolaemia and severe thrombocytopenia, as described in the study by 1
- Central venous catheter and urinary catheter insertion to monitor intravascular volume and urinary output, as discussed in the study by 1
- Corticosteroid administration to promote fetal lung maturity if delivery is planned before 34 weeks of gestation, as recommended by 1
- Prompt delivery once maternal coagulopathy and severe hypertension have been corrected, as emphasized by 1
From the Research
Definition of HELLP Labs
HELLP labs refer to a set of laboratory tests used to diagnose and monitor the HELLP syndrome, a serious complication in pregnancy characterized by:
- Hemolysis (breakdown of red blood cells)
- Elevated Liver enzymes
- Low Platelet count
Laboratory Tests for HELLP Syndrome
The following laboratory tests are used to diagnose and monitor the HELLP syndrome:
- Complete blood count (CBC) with peripheral smear 2
- Lactate dehydrogenase (LDH) 2, 3, 4
- Serum transaminases (AST, ALT) 2, 3, 4
- Urinalysis 2
- Serum haptoglobin 2
- D-dimer fragment levels 2
- Lactate dehydrogenase isoenzymes 2
- Total bilirubin 2
- Prothrombin times (PT) 2
- Activated partial thromboplastin times (aPTT) 2
Key Tests for Monitoring the Disease
The two best tests to monitor the course of the disease are:
Importance of Laboratory Tests
Laboratory tests play a crucial role in the diagnosis, follow-up, and treatment of patients with the HELLP syndrome 2. Prompt delivery is the treatment of choice, and the intensity of the HELLP syndrome peaks 24 hours after delivery 2. Therapeutic plasma exchange (TPE) has been shown to improve treatment outcomes in patients with HELLP syndrome, especially when initiated within 24 hours of diagnosis 4.