HELLP syndrome

Laboratory criteria for HELLP syndrome

The following laboratory criteria should be met for a diagnosis of HELLP syndrome:[1]Sibai BM, Ramadan MK, Usta I, et al. Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes and low platelets (HELLP syndrome). Am J Obstet Gynecol. 1993 Oct;169(4):1000-6. http://www.ncbi.nlm.nih.gov/pubmed/8238109?tool=bestpractice.com [10]Sibai BM. Diagnosis and management of gestational hypertension and preeclampsia. Obstet Gynecol. 2003 Jul;102(1):181-92. http://www.ncbi.nlm.nih.gov/pubmed/12850627?tool=bestpractice.com [30]Martin JN Jr, Rose CH, Briery CM. Understanding and managing HELLP syndrome: the integral role of aggressive glucocorticoids for mother and child. Am J Obstet Gynecol. 2006 Oct;195(4):914-34. http://www.ncbi.nlm.nih.gov/pubmed/16631593?tool=bestpractice.com

• Haemolysis, as evidenced by the presence of schistocytes, burr cells, and polychromasia on a peripheral smear. However, peripheral blood smears are not routinely performed in clinical practice, and sufficient evidence of haemolysis can be gained from:

  • Elevated LDH: >600 IU/L or twice the upper limit of normal concentration

  • Elevated bilirubin: >1.2 mg/dL (5.1 micromol/L)

  • Low serum haptoglobin (rarely performed in practice)

• Elevated liver transaminases: aspartate aminotransferase and/or alanine aminotransferase >70 IU/L, or twice the upper limit of normal concentration not accounted for by alternative diagnoses

• Thrombocytopenia: platelets <100,000/microlitre (<100 x 10⁹/L).