HELLP

 Q: To establish the diagnosis of HELLP syndrome, the cut-off point for platelet count is? (select one)

A) Less than 10,000 cells/microL 

B) Less than 50,000 cells/microL 

C) Less than 100,000 cells/microL 

D) No established cutoff point for low platelets

Answer: C

HELLP syndrome which stands for hemolysis, elevated liver enzymes, and low platelets usually occurs between 28 and 37 weeks of gestation and can be fatal. There are many criteria established to diagnose this syndrome. Most criteria depend on laboratory work to establish the above three entities of the syndrome including blood smear. 

Blood workup usually includes serum bilirubin, haptoglobin, lactate dehydrogenase (LDH), hematocrit, AST, ALT, and platelets levels. Most criteria accept platelet levels below 100,000 cells/microL. 

Infrequently used is the Mississippi classification, which further subclassifies HELLP syndrome depending on its severity.

#Ob-gyn

#hematology

References:

1. Audibert F, Friedman SA, Frangieh AY, Sibai BM. Clinical utility of strict diagnostic criteria for the HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. Am J Obstet Gynecol 1996; 175:460. 

2. Ditisheim A, Sibai BM. Diagnosis and Management of HELLP Syndrome Complicated by Liver Hematoma. Clin Obstet Gynecol 2017; 60:190. 

3. Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222. Obstet Gynecol 2020; 135:e237.