HELLP syndrome: an atypical

presentation
Subject
• Case of a 33-year-old primigravida at 31 weeks gestation with a chief
complaint of sudden shortness of breath. The patient also
complained of an intense, sharp, stabbing midsternal chest pain
(intensity 9/10) radiating to the back. The patient indicated that the
pain intensified with deep breathing or when lying flat on her
back/stomach. The patient also has a history of smoking, which
continued during pregnancy.
Objective
• BP 122/82 mmHg
• Pulse 84x /min
• RR 20x/min
• Hemoglobin 13.7 g/dL,
• Hematocrit of 41%
• Trombosit 179,000 mm3
• Creatinine of 0.8 mg/dL,
• Aspartate aminotransferase (AST) 94
IU/L
• Alanine transaminase (ALT) 153 IU/L
• Total bilirubin 0.5 mg/dL
• Urinalysis  negative for protein
• CT scan  decreased attenuation in
the distal branches of both right and
left lower lobe pulmonary arteries 
suspicious of bilateral pulmonary
emboli.
• Venous Doppler studies of the lower
extremities  negative.
• Fetal ultrasound  estimated fetal
weight of 10th percentile and a
biophysical profile of 8/8.
Assessment
• Pulmonary Embolism

Planning
• IV heparin (therapeutic dose)
• Maintened on low moleucular weight heparin at 10.000 unit/12jam
Subject
• Chief complaint  acute epigastric pain regarding to the back
• Onset 6 hours, moderate to severe intensity

Objective
• BP 136/71 mmHg • Ht 35%
• Pulse 68x / min • Trombosit 142.000 mm3
• RR 24x/ min • SGOT 192 IU/L
• SGPT 183 IU/L
Objective
• Lmwh discontinued

• Trombosit dropped 42.000 mm3 and Ht 27%

• Emergent placement of an anterior vena cava filter and cesarean

section
Intraoperative Findings
• massive hemoperitoneum and a diffusely congested liver with 2
capsular hematomas covering areas of spontaneous rupture.

Post operative diagnosis

• HELLP syndrome
 Hemolysis Elevated Liver
HELLP
Enzymes and Low Platelets