Management of patients with HELLP syndrome

HELLP: hemolysis, elevated liver enzymes, and low platelets; LDH: lactate dehydrogenase; AST: aspartate transaminase; ALT: alanine transaminase.
* Criteria for HELLP: 

• Hemolysis, established by at least 2 of the following: 
  • Peripheral smear with schistocytes and burr cells
  • Serum bilirubin ≥1.2 mg/dL (20.52 micromol)
  • Low serum haptoglobin (≤25 mg/dL) or LDH ≥2 times the upper level of normal (in the local laboratory)
  • Severe anemia, unrelated to blood loss
• Elevated liver enzymes:
  • AST or ALT ≥2 times the upper level of normal (in the local laboratory)
• Low platelets: <100,000 cells/microL

¶ Patients with severe epigastric or right upper quadrant pain should undergo an appropriate imaging study expeditiously to evaluate for hepatic bleeding, even if liver enzymes are not severalfold above the normal range.
Δ The mother and fetus should be closely monitored during this period. Refer to UpToDate content on HELLP syndrome.