Preeclampsia vs HELLP syndrome
How to tell Preeclampsia and HELLP syndrome apart when a board question makes them look alike.
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Platelets below 100000/uL with hemolysis marks HELLP syndrome.
Side by side
New hypertension after 20 weeks with proteinuria or end-organ features without the full HELLP triad suggests preeclampsia.
Hemolysis, elevated AST or ALT, and platelets below 100000/uL in a hypertensive pregnancy indicate HELLP syndrome.
Placental endothelial dysfunction causes maternal vasoconstriction and multiorgan injury.
Severe microangiopathic endothelial injury in pregnancy leads to hemolysis, hepatic injury, and thrombocytopenia.
Preeclampsia criteria include blood pressure at least 140/90 after 20 weeks with proteinuria at least 300 mg in 24 hours or severe features such as creatinine above 1.1 mg/dL.
HELLP shows platelets below 100000/uL, AST or ALT often above 70 U/L, elevated LDH above 600 U/L, and evidence of hemolysis on smear or bilirubin rise.
The trap
Attributing right upper quadrant pain and nausea to benign pregnancy discomfort delays HELLP recognition. Falling platelets and rising liver enzymes require urgent delivery planning after maternal stabilization.
The repair move
Next best step: give magnesium sulfate 4 g IV loading then 1 to 2 g/hour infusion for seizure prophylaxis, control severe blood pressure with IV labetalol 20 mg then escalating doses or hydralazine, administer corticosteroids for fetal lung maturity if gestational age is appropriate, and proceed to delivery once maternal stabilization is achieved because delivery is definitive therapy for HELLP and severe preeclampsia.
Try a free question
CoreA 33-year-old at 35 weeks has BP 170/114 mm Hg, headache, platelets 68000/uL, AST 160 U/L, and hemolysis labs. What is the next best step in management?
Show answer and explanation
Answer: A. Magnesium sulfate, severe blood pressure control, and delivery planning. This is HELLP syndrome with severe features requiring immediate maternal stabilization and delivery pathway.
Why the other choices are tempting
- B. Wrong. Outpatient delay is unsafe in severe disease.
- C. Wrong. Expectant waiting increases risk of maternal and fetal complications.
- D. Wrong. Iron does not treat HELLP pathophysiology.
- E. Wrong. Symptom-only treatment is inadequate.
Flashcards
Tap a card to flip it.
Which laboratory threshold is most useful for identifying HELLP in a hypertensive pregnancy?
Platelets below 100000/uL with hemolysis and elevated liver enzymes.
What medication is first-line seizure prophylaxis in severe preeclampsia or HELLP?
Magnesium sulfate infusion.
Quick answers
What is the fastest way to tell Preeclampsia from HELLP syndrome?
Platelets below 100000/uL with hemolysis marks HELLP syndrome.
What is the key clue for Preeclampsia?
New hypertension after 20 weeks with proteinuria or end-organ features without the full HELLP triad suggests preeclampsia.
What is the key clue for HELLP syndrome?
Hemolysis, elevated AST or ALT, and platelets below 100000/uL in a hypertensive pregnancy indicate HELLP syndrome.
What is the common trap with Preeclampsia vs HELLP syndrome?
Attributing right upper quadrant pain and nausea to benign pregnancy discomfort delays HELLP recognition. Falling platelets and rising liver enzymes require urgent delivery planning after maternal stabilization.