HELLP Syndrome with Unusual Features in a Rare Setting

Collins Amadi; Bright Amadi

doi:doi:10.11648/j.ejcbs.20210706.20

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HELLP Syndrome with Unusual Features in a Rare Setting

Collins Amadi, Bright Amadi

Published in European Journal of Clinical and Biomedical Sciences (Volume 7, Issue 6)

Received: 23 November 2021 Accepted: 10 December 2021 Published: 24 December 2021

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Abstract

HELLP (Hemolysis, Elevated Liver enzymes, and Low Platelet) syndrome is a rare disorder exclusively associated with pregnancy. It occurs mostly during the antepartum period in about 70% of cases but could also occur during the post-partum period in about 30% of reported cases especially during the first 48 hours following delivery. The syndrome is mostly reported among multiparous Caucasians in association with severe preeclampsia, hypertension, and proteinuria. It is rarely reported within Nigeria and the post-partum variant has never been documented among women of Nigerian origin in the literature to date. Herein, we report a very unusual case of HELLP syndrome in a very rare setting that developed eleven days post-partum without the usual features of hypertension and proteinuria in a 26-year-old G1P1. Upon presentation, she was promptly diagnosed and aggressively managed using standard protocols by a multidisciplinary medical team of specialists. She developed acute kidney injury (KDIGO stage 1) in the course of management of which she required conservative management. Remarkably, with supportive care, all the clinical and laboratory derangements, including hepatic and renal functions, normalized after seven days on admission. Her condition remained stable during weekly follow-up visits for four consecutive weeks. This case and its management protocols reinforce the need for a high index of clinical suspicion for this dreaded disorder and its prompt diagnosis/aggressive management even in very rare circumstances and settings.

Published in	European Journal of Clinical and Biomedical Sciences (Volume 7, Issue 6)
DOI	10.11648/j.ejcbs.20210706.20
Page(s)	155-160
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

HELLP, HELLP Syndrome, Class 3 HELLP Syndrome

References

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[2]	Poimenidi E, Metodiev Y, Archer NN, Jackson R, Bangash MN, Howells PA. Haemolysis, elevated liver enzymes and low platelets: Diagnosis and management in critical care. J Intensive Care Society. 2021; 0 (0): 1–7. DOI: 10.1177/17511437211025410.
[3]	Burwick RM, Moyle K, Java A, Gupta M. Differentiating Hemolysis, Elevated Liver Enzymes, and Low Platelet Count Syndrome and Atypical Hemolytic Uremic Syndrome in the Postpartum Period. Hypertension. 2021; 78 (3): 760-8.
[4]	Westbrook RH, Dusheiko G, Williamson C. Pregnancy and liver disease. J Hepatol 2016; 64: 933–45.
[5]	Rimaitis K, Grauslyte L, Zavackiene A, Baliuliene V, Nadisauskiene R, Macas A. Diagnosis of HELLP syndrome: a 10-year survey in a perinatology centre. Int J Environ Res Public Health. 2019; 16 (1): 109. DOI: 10.3390/ijerph16010109.
[6]	Dusse LM, Alpoim PN, Silva JT, Rios DR, Brandão AH, Cabral AC. Revisiting HELLP syndrome. Clinica Chimica Acta. 2015; 451: 117-20.
[7]	McCormick PA, Higgins M, McCormick CA, Nolan N, Docherty JR. Hepatic infarction, hematoma, and rupture in HELLP syndrome: support for a vasospastic hypothesis. J Matern Fetal Neonatal Med. 2021 15: 1-6. DOI: 10.1080/14767058.2021.1939299.
[8]	Shelat PM, Vyas RC, Shah SR, Nathwani ND. Fetomaternal outcome in pregnancy with HELLP syndrome. Int Reprod Contracept Obstet Gynecol. 2020; 9 (7): 2860-6.
[9]	Socolov D, Ilea C, Lupascu IA, Blidaru I, Luca A, Radescu M, et al. Maternal-fetal prognosis in HELLP syndrome in a level 3 maternal-fetal care centre. Clin Exp Obstet Gynecol. 2021; 43 (3): 374-8.
[10]	Fallatah HI, Al-Dabbagh AA, Mimish HL, Al-Sahafi MA, Akbar HO. Liver diseases in pregnancy and outcomes: A retrospective study from Saudi Arabia. Afri J Reprod Health. 2021; 25 (3): 121-9.
[11]	Socolov D, Ilea C, Lupascu IA, Blidaru I, Luca A, Radescu M, Carauleanu A, Socolov R. Maternal-fetal prognosis in HELLP syndrome in a level 3 maternal-fetal care centre. Clin Exp Obstetrics Gynecol. 2021; 43 (3): 374-8.
[12]	Nakamura K, Inokuchi R, Sonoo T, Hiruma T, Tokunaga K, Doi K. Late postpartum HELLP syndrome over 10 days after delivery. Am J Emerg Med. 2016; 34 (11): 2258-e1.
[13]	Booker WA. Hypertensive Disorders of Pregnancy. Clin Perinatol. 2020; 47 (4): 817-33.
[14]	MN S. A Maternal Mortality in the Case of HELLP Syndrome: An Avertable Loss. Indian J Forensic Med Toxicol. 2019; 13 (4).
[15]	Nam IC, Won JH, Kim S, Bae K, Jeon KN, Moon JI, Cho E, Park JE, Jang JY, Park SE. Transcatheter Arterial Embolization for Spontaneous Hepatic Rupture Associated with HELLP Syndrome: A Case Report. Medicina. 2021; 57 (10): 1055.
[16]	Sasamori Y, Tanaka A, Ayabe T. Liver disease in pregnancy. Hepatol Res. 2020: 50 (9): 1015-23.
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APA Style

Collins Amadi, Bright Amadi. (2021). HELLP Syndrome with Unusual Features in a Rare Setting. European Journal of Clinical and Biomedical Sciences, 7(6), 155-160. https://doi.org/10.11648/j.ejcbs.20210706.20

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ACS Style

Collins Amadi; Bright Amadi. HELLP Syndrome with Unusual Features in a Rare Setting. Eur. J. Clin. Biomed. Sci. 2021, 7(6), 155-160. doi: 10.11648/j.ejcbs.20210706.20

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AMA Style

Collins Amadi, Bright Amadi. HELLP Syndrome with Unusual Features in a Rare Setting. Eur J Clin Biomed Sci. 2021;7(6):155-160. doi: 10.11648/j.ejcbs.20210706.20

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@article{10.11648/j.ejcbs.20210706.20,
  author = {Collins Amadi and Bright Amadi},
  title = {HELLP Syndrome with Unusual Features in a Rare Setting},
  journal = {European Journal of Clinical and Biomedical Sciences},
  volume = {7},
  number = {6},
  pages = {155-160},
  doi = {10.11648/j.ejcbs.20210706.20},
  url = {https://doi.org/10.11648/j.ejcbs.20210706.20},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ejcbs.20210706.20},
  abstract = {HELLP (Hemolysis, Elevated Liver enzymes, and Low Platelet) syndrome is a rare disorder exclusively associated with pregnancy. It occurs mostly during the antepartum period in about 70% of cases but could also occur during the post-partum period in about 30% of reported cases especially during the first 48 hours following delivery. The syndrome is mostly reported among multiparous Caucasians in association with severe preeclampsia, hypertension, and proteinuria. It is rarely reported within Nigeria and the post-partum variant has never been documented among women of Nigerian origin in the literature to date. Herein, we report a very unusual case of HELLP syndrome in a very rare setting that developed eleven days post-partum without the usual features of hypertension and proteinuria in a 26-year-old G1P1. Upon presentation, she was promptly diagnosed and aggressively managed using standard protocols by a multidisciplinary medical team of specialists. She developed acute kidney injury (KDIGO stage 1) in the course of management of which she required conservative management. Remarkably, with supportive care, all the clinical and laboratory derangements, including hepatic and renal functions, normalized after seven days on admission. Her condition remained stable during weekly follow-up visits for four consecutive weeks. This case and its management protocols reinforce the need for a high index of clinical suspicion for this dreaded disorder and its prompt diagnosis/aggressive management even in very rare circumstances and settings.},
 year = {2021}
}

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TY  - JOUR
T1  - HELLP Syndrome with Unusual Features in a Rare Setting
AU  - Collins Amadi
AU  - Bright Amadi
Y1  - 2021/12/24
PY  - 2021
N1  - https://doi.org/10.11648/j.ejcbs.20210706.20
DO  - 10.11648/j.ejcbs.20210706.20
T2  - European Journal of Clinical and Biomedical Sciences
JF  - European Journal of Clinical and Biomedical Sciences
JO  - European Journal of Clinical and Biomedical Sciences
SP  - 155
EP  - 160
PB  - Science Publishing Group
SN  - 2575-5005
UR  - https://doi.org/10.11648/j.ejcbs.20210706.20
AB  - HELLP (Hemolysis, Elevated Liver enzymes, and Low Platelet) syndrome is a rare disorder exclusively associated with pregnancy. It occurs mostly during the antepartum period in about 70% of cases but could also occur during the post-partum period in about 30% of reported cases especially during the first 48 hours following delivery. The syndrome is mostly reported among multiparous Caucasians in association with severe preeclampsia, hypertension, and proteinuria. It is rarely reported within Nigeria and the post-partum variant has never been documented among women of Nigerian origin in the literature to date. Herein, we report a very unusual case of HELLP syndrome in a very rare setting that developed eleven days post-partum without the usual features of hypertension and proteinuria in a 26-year-old G1P1. Upon presentation, she was promptly diagnosed and aggressively managed using standard protocols by a multidisciplinary medical team of specialists. She developed acute kidney injury (KDIGO stage 1) in the course of management of which she required conservative management. Remarkably, with supportive care, all the clinical and laboratory derangements, including hepatic and renal functions, normalized after seven days on admission. Her condition remained stable during weekly follow-up visits for four consecutive weeks. This case and its management protocols reinforce the need for a high index of clinical suspicion for this dreaded disorder and its prompt diagnosis/aggressive management even in very rare circumstances and settings.
VL  - 7
IS  - 6
ER  -

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Author Information

Collins Amadi

Department of Chemical Pathology, Rivers State University, Port Harcourt, Nigeria
Bright Amadi

Department of Chemical Pathology, Rivers State University, Port Harcourt, Nigeria

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APA Style

Collins Amadi, Bright Amadi. (2021). HELLP Syndrome with Unusual Features in a Rare Setting. European Journal of Clinical and Biomedical Sciences, 7(6), 155-160. https://doi.org/10.11648/j.ejcbs.20210706.20

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ACS Style

Collins Amadi; Bright Amadi. HELLP Syndrome with Unusual Features in a Rare Setting. Eur. J. Clin. Biomed. Sci. 2021, 7(6), 155-160. doi: 10.11648/j.ejcbs.20210706.20

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AMA Style

Collins Amadi, Bright Amadi. HELLP Syndrome with Unusual Features in a Rare Setting. Eur J Clin Biomed Sci. 2021;7(6):155-160. doi: 10.11648/j.ejcbs.20210706.20

Copy | Download

@article{10.11648/j.ejcbs.20210706.20,
  author = {Collins Amadi and Bright Amadi},
  title = {HELLP Syndrome with Unusual Features in a Rare Setting},
  journal = {European Journal of Clinical and Biomedical Sciences},
  volume = {7},
  number = {6},
  pages = {155-160},
  doi = {10.11648/j.ejcbs.20210706.20},
  url = {https://doi.org/10.11648/j.ejcbs.20210706.20},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ejcbs.20210706.20},
  abstract = {HELLP (Hemolysis, Elevated Liver enzymes, and Low Platelet) syndrome is a rare disorder exclusively associated with pregnancy. It occurs mostly during the antepartum period in about 70% of cases but could also occur during the post-partum period in about 30% of reported cases especially during the first 48 hours following delivery. The syndrome is mostly reported among multiparous Caucasians in association with severe preeclampsia, hypertension, and proteinuria. It is rarely reported within Nigeria and the post-partum variant has never been documented among women of Nigerian origin in the literature to date. Herein, we report a very unusual case of HELLP syndrome in a very rare setting that developed eleven days post-partum without the usual features of hypertension and proteinuria in a 26-year-old G1P1. Upon presentation, she was promptly diagnosed and aggressively managed using standard protocols by a multidisciplinary medical team of specialists. She developed acute kidney injury (KDIGO stage 1) in the course of management of which she required conservative management. Remarkably, with supportive care, all the clinical and laboratory derangements, including hepatic and renal functions, normalized after seven days on admission. Her condition remained stable during weekly follow-up visits for four consecutive weeks. This case and its management protocols reinforce the need for a high index of clinical suspicion for this dreaded disorder and its prompt diagnosis/aggressive management even in very rare circumstances and settings.},
 year = {2021}
}

Copy | Download

TY  - JOUR
T1  - HELLP Syndrome with Unusual Features in a Rare Setting
AU  - Collins Amadi
AU  - Bright Amadi
Y1  - 2021/12/24
PY  - 2021
N1  - https://doi.org/10.11648/j.ejcbs.20210706.20
DO  - 10.11648/j.ejcbs.20210706.20
T2  - European Journal of Clinical and Biomedical Sciences
JF  - European Journal of Clinical and Biomedical Sciences
JO  - European Journal of Clinical and Biomedical Sciences
SP  - 155
EP  - 160
PB  - Science Publishing Group
SN  - 2575-5005
UR  - https://doi.org/10.11648/j.ejcbs.20210706.20
AB  - HELLP (Hemolysis, Elevated Liver enzymes, and Low Platelet) syndrome is a rare disorder exclusively associated with pregnancy. It occurs mostly during the antepartum period in about 70% of cases but could also occur during the post-partum period in about 30% of reported cases especially during the first 48 hours following delivery. The syndrome is mostly reported among multiparous Caucasians in association with severe preeclampsia, hypertension, and proteinuria. It is rarely reported within Nigeria and the post-partum variant has never been documented among women of Nigerian origin in the literature to date. Herein, we report a very unusual case of HELLP syndrome in a very rare setting that developed eleven days post-partum without the usual features of hypertension and proteinuria in a 26-year-old G1P1. Upon presentation, she was promptly diagnosed and aggressively managed using standard protocols by a multidisciplinary medical team of specialists. She developed acute kidney injury (KDIGO stage 1) in the course of management of which she required conservative management. Remarkably, with supportive care, all the clinical and laboratory derangements, including hepatic and renal functions, normalized after seven days on admission. Her condition remained stable during weekly follow-up visits for four consecutive weeks. This case and its management protocols reinforce the need for a high index of clinical suspicion for this dreaded disorder and its prompt diagnosis/aggressive management even in very rare circumstances and settings.
VL  - 7
IS  - 6
ER  -

Copy | Download