O135. HELLP??? – A case

Abstract

Introduction HELLP affects about 1% of all pregnancies and up to 20% of pregnant women with severe preeclampsia/eclampsia. Clinical symptoms are typically associated with right upper epigastric pain, headache and visual disturbance. In about 15–20% patients present without hypertension and/or proteinuria. Objectives After delivery symptoms and lab tests of HELLP resolve gradually within 3–4 days, in case of persistent disease awareness for other thrombotic micorangiopathies has to be raised. Methods We present a case of a 26 year old primigravida, who presented in her 35+1 week of gestational age in our labour ward with epigastric pain and starting labour. Further clinical signs (mild hypertension and proteinuria) and her massively deranged lab results suggested severe HELLP with haemolytic anaemia and profound thrombocytopenia (9G/l). After ordering a thrombelastogram (TEG) and short preparation with cortison and blood products an uneventful cesarean section was performed. A healthy boy was born (2480 g/47 cm length; Apgar 7/8/10; umbilical a/v pH 7.29/7.30), but unfortunately his mother’s recovery took an unexpected course, continuing lab tests suggested a thrombotic microangiopathy (TTP/aHUS) and accordingly therapy was started, but nevertheless she died on day 13 after delivery. Results We discuss her disease, management and differential diagnosis in review of the literature. Conclusions In pregnant patients with severe thrombocytopenia and microangiopathic haemolytic anaemia and other symptoms suggesting severe HELLP other thrombotic microangiopathies have to be excluded.