Thrombocytopenia in early pregnancy predicting partial haemolysis, elevated liver enzyme and low platelet count syndrome: a case report and review of literature

Kavitha Nagandla, Krishna Kumar


The incidence of thrombocytopenia in pregnancy is 6-10% and is classically defined as a platelet count of less than 150,000/ L. Counts less than 100,000 to 150,000/L are considered mild, 50,000 to 100,000/L as moderate, and less than 50,000/L are considered as severe thrombocytopenia. It is the second most common hematological condition in pregnancy with anaemia being the leading cause. Thrombocytopenia may be related to disorders that are intrinsic to pregnancy such as gestational thrombocytopenia that is seen in three-fourths of all cases. The second common cause is hypertensive disorders in pregnancy more commonly seen in severe pre-eclampsia in 21% and in HELLP (haemolysis, elevated liver enzyme and low platelet count) that accounts for 12% of thrombocytopenia cases in pregnancy. This case report revisits the diagnosis of partial HELLP under the background of preeclampsia that warrants aggressive treatment like complete HELLP syndrome to optimize the maternal and fetal outcome.


Pregnancy, Thrombocytopenia, HELLP syndrome

Full Text:



Shehata N, Burrows R, Kelton JG. Gestational thrombocytopenia. Clin Obstet Gynecol. 1999;42:327-34.

Burrows RF, Kelton JG. Thrombocytopenia at delivery: a prospective survey of 6,715 deliveries. Am J Obstet Gynecol. 1990;162:731-4.

Magann EF, Martin JN. Twelve steps to optimal management of HELLP syndrome. Clin Obstet Gynecol. 1999;42:532-50.

Sullivan CA, Martin JN. Management of the obstetric patient with thrombocytopenia. Clin Obstet Gynecol. 1995;38:521-34.

Rath W, Faridi A, Dudenhausen JW. HELLP syndrome. Peri-nat Med. 2000;28:249-60.

Veena HC, Manjunatha S, Itagi V, Taklikar RH, Patil RS. The hemostatic mechanisms in PIH. Indian J Appl Basic Med Sci. 2015;17:40-4.

Silver R, Berkowitz R, Bussel J. Thrombocytopeniain pregnancy. Practice bulletin, No 6. Chicago: American College of Obstetrics and Gynecology; 1999.

McCrae KR. Thrombocytopenia in pregnancy. Hematology Am Soc Hematol Educ Program. 2010:397-402.

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

Weinstein L. Syndrome of haemolysis, elevated liver enzymes and low platelet count: a severe consequence of hypertensionin pregnancy. Am J Obstet Gynecol. 1982;142:159-67.

Sibai BM. Treatment of hypertension in pregnant woman. N Eng J Med. 1996;335:257-60.

Sibai BM. The HELLP syndrome (haemolysis, elevated liver enzymes, and low platelets): much ado about nothing. Am J Obstet Gynecol. 1990;162:311-6.

Abramovici D, Friedman SA, Mercer BM, Audibert F, Kao L, Sibai BM. Neonatal outcome in severe preeclampsia at 24 to 36 weeks’ gestation: does the HELLP hemolysis, elevated liver enzymes, and low platelet count) syndrome matter? Am J Obstet Gynecol. 1999;180:221-5.

Abbade JF, Peracoli JC, Costa Araujo RA. Sao Paulo Med J/Rev Paul Med. 2002;120(6):180-4.

Liu CM, Chang SD, Chang PJ, Cha AS. Comparison of maternal and perinatal outcomes in Twainese women with complete and partial HELLP syndrome and women with severe preeclampsia without HELLP. Obstet Gynaecol. 2006;32(6):550-8.

Rakshit A, Lahiri S, Biswas SC, Dey R, Roy BR, Saha MM. A study to detect HELLP syndrome and partial HELLP syndrome among pre-eclamptic mothers and their impact in fetomaternal outcome Al Ameen J Med Sci. 2014;7(1):20-5.

Martin JN, Owens MY, Keiser SD, Parrish MR, Tam Tam KB, Brewer JM, et al. Standardized Mississippi protocol treatment of 190 patients with HELLP syndrome: slowing disease progression and preventing new major maternal morbidity. Hypertens Pregnancy. 2012;31:79-90.

Woudstra DM, Chandra S, Hofmeyr GJ, Dowswell T. Corticosteroids for HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome in pregnancy. Cochrane Database Syst Rev. 2010;8(9):CD008148.