Partial HELLP syndrome: case report

Sheetal Dagar, Monika Gupta, Vrinda Shekhawat, Santosh Minhas


HELLP syndrome is a complication in pregnancy clustered by haemolysis, elevated liver enzymes, and a low platelet count. It is seen as a serious complication of preeclampsia and eclampsia. Serious manifestations like haemorrhage, infarction, rupture and other hepatic manifestations are usually associated with it. In this case study, 29 years old primigravida is a booked case admitted in ward at 39 weeks 1 day with decreased fetal movement for 2 days. No history of pain abdomen, bleeding per vaginum, discharge per vaginum. Her blood pressure records at the time of admission was 110/72 mmHg and she was normotensive throughout pregnancy. Urine routine examination was negative for urinary protein. However, blood tests showed platelet count of 66,1000/cumm, with ALT of 174 U/L and AST of 123 U/L on peripheral blood film. RBC were predominantly normocytic, normochromic with few macrocytes. WBC has normal morphology. Platelets were reduced on smear. Giant platelets were seen. Ursodeoxycholic acid 300 mg 12 hourly were given to the patient and 3 doses of vitamin K I/M 24 hourly. She was delivered by cesarean section which was performed due to failure of progression of labor with a deflexed head. There was presence of retroplacental clot of 4×3 cm indicating placental abruption, a complication of HELLP syndrome. From this we conclude that we should be careful in suspecting complications of full blown diseases even when the patients are asymptomatic but have atypical laboratory findings.


Abruption, Low liver enzymes, Partial HELLP, Thrombocytopenia

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Stone JH. HELLP syndrome: hemolysis, elevated liver enzymes, and low platelets. JAMA. 1998;280:559.

Sibai BM. Diagnosis, controversies, and management of the syndrome of hemolysis, elevated liver enzymes, and low platelet count. Obstet Gynecol. 2004;103:981-91.

Yang Z, Yamada J, Zhao Y. Prospective screening for pediatric mitochondrial trifunctional protein defects in pregnancies complicated by liver disease. JAMA. 2002;288:2163.

Yang Z, Zhao Y, Bennett MJ. Fetal genotypes and pregnancy outcomes in 35 families with mitochondrial trifunctional protein mutations. Am J Obstet Gynecol. 2002;187:715.

Lachmeijer AM, Arngrı ́msson R, Bastiaans EJ. A genome-wide scan for preeclampsia in the Netherlands. Eur J Hum Genet. 2001;9:758.

Abildgaard U, Heimdal K. Pathogenesis of the syndrome of hemolysis, elevated liver enzymes, and low platelet count(HELLP): a review. Eur J Obstet Gynecol Reprod Biol. 2013;166:17.

Bhattacharya S, Campbell DM. The incidence of severe complications of preeclampsia. Hypertens Pregnancy. 2005;24:181-90.

Barton JR, Sibai BM. Diagnosis and management of hemolysis, elevated liver enzymes, and low platelets syndrome. Clin Perinatol. 2004;31:807-33.