What is HELLP syndrome and its diagnostic criteria?

HELLP is an acronym that refers to a syndrome in pregnant and postpartum individuals characterized by hemolysis with a microangiopathic blood smear, elevated liver enzymes, and a low platelet count [1].

How is HELLP syndrome defined?

HELLP syndrome is a pregnancy complication that affects the blood and liver. It’s a medical emergency that needs quick treatment. Signs and symptoms of HELLP include blurry vision, chest pain or pain in the upper right or middle part of the belly, swelling and throwing up.

What is the pathophysiology of HELLP syndrome?

HELLP is a syndrome characterized by thrombocytopenia, hemolytic anemia, and liver dysfunction believed to result from microvascular endothelial activation and cell injury. The pathophysiology of HELLP syndrome is ill-defined.

What is the difference between preeclampsia and HELLP syndrome?

Preeclampsia is an important disease affecting maternal and fetal health worldwide (1). Hemolysis, Elevated Liver enzymes, Low Platelet (HELLP) Syndrome is considered a more severe form of preeclampsia (2).

When is HELLP syndrome diagnosed?

This condition is marked by high blood pressure, and it typically occurs during the last trimester of pregnancy. However, it may present earlier in the pregnancy or postpartum (in rare cases). Not all pregnant women with preeclampsia will develop HELLP syndrome.

How do you test for HELLP syndrome?

HELLP syndrome is diagnosed when laboratory tests show hemolysis (burst red blood cells release hemoglobin into the blood plasma), elevated liver enzymes, and low platelets. There also may or may not be extra protein in the urine.

What liver enzymes are elevated in HELLP syndrome?

Liver enzyme abnormalities are seen in up to 10% of pregnant women with severe preeclampsia. These include two‐ to three‐fold elevation in alanine and aspartate aminotransferases. The frequency and severity of elevation of liver aminotransferases are much higher in HELLP syndrome than in severe preeclampsia.

Is HELLP syndrome eclampsia?

HELLP syndrome is a life-threatening condition frequently associated with severe preeclampsia-eclampsia and is characterized by three hallmark features of hemolysis, elevated liver enzymes and low platelets.

When does preeclampsia become HELLP?

HELLP syndrome

It’s most likely to occur immediately after the baby is delivered, but can appear any time after 20 weeks of pregnancy, and in rare cases before 20 weeks. The letters in the name HELLP stand for each part of the condition: “H” is for haemolysis – this is where the red blood cells in the blood break down.

Do you have to have preeclampsia to have HELLP?

Although most women who develop HELLP syndrome already have high blood pressure and preeclampsia, sometimes the syndrome is the first sign. In addition, HELLP syndrome can occur without a woman having either high blood pressure or protein in her urine.

What is considered a high LDH level in pregnancy?

We find that elevated LDH levels are associated with adverse maternal and neonatal outcomes in hypertension and preeclampsia, independent of hemolysis, elevated liver enzymes, and low platelet count syndrome. Therefore, elevated LDH levels (≥1.6× normal or ≥400 U/L) may be considered a severe feature of preeclampsia.

How quickly does HELLP syndrome develop?

Most often, HELLP develops during the third trimester of pregnancy (between 26 to 40 weeks gestation). Sometimes it develops in the week after the baby is born. Many women have high blood pressure and are diagnosed with preeclampsia before they develop HELLP syndrome.

How long after childbirth does HELLP occur?

Up to 30% of all patients who develop HELLP syndrome will develop this syndrome after parturition, typically within 48 hours.

What is the normal range of lactate dehydrogenase?

Normal Results

Normal value range is 105 to 333 international units per liter (IU/L). Normal value ranges may vary slightly among different laboratories. Some labs use different measurements or test different samples.

What protein level is preeclampsia?

ACOG currently recommends diagnosing preeclampsia with either a 24 hour value or a P:C in a single voided urine (4). A ratio > 0.3 mg/dL has been shown to meet or exceed 300 mg protein on a 24 hr urine (5).

How high is too high for LDH?

Normal levels of LDH in the blood can vary depending on the lab, but usually range between 140 units per liter (U/L) to 280 U/L for adults and tend to be higher for children and teens. In cerebrospinal fluid, normal levels are: Less than 70 U/L for newborns. Less than 40 U/L for adults.

What causes high lactate levels?

The increase in lactate production is usually caused by impaired tissue oxygenation, either from decreased oxygen delivery or a defect in mitochondrial oxygen utilization.

Why LDH test is done?

LDH is found in many of the body’s tissues and organs, including the muscles, liver, heart, pancreas, kidneys, brain and blood cells. The LDH test is mainly used to help identify the location and severity of tissue damage in the body. It’s also sometimes used to monitor how far certain conditions have progressed.

How do you reduce lactate dehydrogenase?

Medicines with ascorbic acid (vitamin C) can decrease your LDH levels. Alcohol also can affect your LDH levels.

What are 3 symptoms of lactic acid build up?

Muscle ache, burning, rapid breathing, nausea, stomach pain: If you’ve experienced the unpleasant feeling of lactic acidosis, you likely remember it. Lactic acidosis caused by intense exercise is usually temporary. It happens when too much acid builds up in your bloodstream.

What level of lactic acid indicates sepsis?

Thus, a serum lactate level >2 mmol/L may be a new emerging vital sign of septic shock.

What are the signs of lactic acidosis?

The symptoms of lactic acidosis include abdominal or stomach discomfort, decreased appetite, diarrhea, fast, shallow breathing, a general feeling of discomfort, muscle pain or cramping, and unusual sleepiness, tiredness, or weakness. If you have any symptoms of lactic acidosis, get emergency medical help right away.

What blood test shows lactic acidosis?

The lactate blood test is primarily ordered to help determine if someone has lactic acidosis, a level of lactate that is high enough to disrupt a person’s acid-base (pH) balance. Lactic acidosis is most commonly caused by an inadequate amount of oxygen in cells and tissues (hypoxia).