HELLP Syndrome USMLE Notes & Mnemonics contains all the high-yield points you need to know.
Definition:
- HELLP Syndrome: A severe form of preeclampsia, characterized by Hemolysis, Elevated Liver enzymes, and Low Platelet count. (Ref)
Pathophysiology:
- Related to Preeclampsia: Considered a variant or complication of preeclampsia.
- Vascular Endothelial Damage: Leading to hemolysis, liver dysfunction, and thrombocytopenia.
Epidemiology:
- Occurs in about 0.5-0.9% of all pregnancies.
- More common in multiparous women.
Clinical Features:
- Symptoms of Preeclampsia: Hypertension, proteinuria, edema.
- Right Upper Quadrant (RUQ) Pain: Due to liver swelling and capsule stretching.
- Nausea and Vomiting: Common gastrointestinal symptoms.
- Headache and Visual Disturbances: Due to hypertension and cerebral edema.
Laboratory Findings:
- Hemolysis: Schistocytes on peripheral smear, elevated LDH.
- Elevated Liver Enzymes: AST, ALT often >2 times the upper limit of normal.
- Low Platelets: <100,000/mm³.
Diagnosis:
- Clinical Diagnosis: Based on the triad of hemolysis, elevated liver enzymes, and low platelets in a pregnant woman, typically after 20 weeks of gestation.
- Exclude Other Causes: Such as viral hepatitis, idiopathic thrombocytopenic purpura (ITP), or thrombotic thrombocytopenic purpura (TTP).
Management:
- Immediate Delivery: Mainstay of treatment; method depends on gestational age and maternal/fetal condition.
- Blood Pressure Control: Antihypertensive medications (e.g., labetalol, hydralazine).
- Corticosteroids: For fetal lung maturity if preterm and to possibly improve platelet count.
- Magnesium Sulfate: For seizure prophylaxis.
- Monitoring: Intensive monitoring of mother and fetus.
Complications:
- Placental Abruption
- Renal Failure
- Disseminated Intravascular Coagulation (DIC)
- Pulmonary Edema
- Liver Hematoma or Rupture
HELLP Syndrome USMLE Mnemonic: “HELLP” for Components
- Hemolysis
- Elevated Liver enzymes
- Low Platelet count
Chart: HELLP Syndrome vs. Preeclampsia
| Feature | HELLP Syndrome | Preeclampsia |
|---|---|---|
| Blood Pressure | Often elevated | Elevated |
| Proteinuria | May be present | Usually present |
| Liver Enzymes | Significantly elevated (AST, ALT) | Normal or mildly elevated |
| Platelets | <100,000/mm³ | Usually normal or slightly decreased |
| Hemolysis | Present (schistocytes, high LDH) | Absent |
| Symptoms | RUQ pain, headache, visual changes, nausea | Headache, visual changes, swelling |
| Treatment | Immediate delivery, BP control, magnesium sulfate | Delivery when stable, BP control, magnesium sulfate |
Note: HELLP syndrome is a critical condition associated with high maternal and fetal morbidity and mortality. On the USMLE, it’s crucial to recognize its signs and symptoms, especially in the context of preeclampsia, and to understand the urgency of its management. Early recognition and prompt delivery are key to improving outcomes.
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