Asad Ali Chaudhry.
HELLP Syndrome.
J Coll Physicians Surg Pak Jan ;12(1):58-9.

A 24 years old female presented with hypertension, haemolysis, elevated liver enzymes and thrombocytopenia in an unconscious state after undergoing an emergency caesarian section. A diagnosis of HELLP syndrome was made on the above findings. Patient made an uneventful recovery with conservative management. A brief review of the literature is included along with the case report. A 24 years old multipara (G2 P1 A0) presented at a local hospital at 36 weeks of gestation with accelerated hypertension and fits. She underwent emergency caesarean section delivering a single alive female baby at Apgar score 2/10. Her previous baby was also delivered by C-section. There was no history of diabetes or hypertension. Antenatal record was not available.

Case Rerport: Upon arrival in the ICU she was unconscious with a Glasgow Coma Scale of 4/15, pulse rate of 114/minute, BP 160/120 mm of Hg and temp. 98oF. She was noted to be pale with facial puffiness. Her heart sounds were normal, chest was clear on auscultation and abdomen was distended with absent bowel sounds. She had bilateral flexor plantars and deep tendon reflexes were absent in all limbs. Pupils were rather constricted with sluggish light reflex and fundi were unremarkable. There were no signs of meningeal irritation. Treatment with intravenous cefotaxime, metronidazole and ranitidine was commenced. She was also given steroids (inj. dexamethasone 8 mg. I/V tds) for 24 hours. Glyceryl trinitrate infusion was initiated to control the blood pressure. Two litres of intravenous fluid were allowed over 24 hours with strict monitoring of urine output. Regular blood glucose monitoring was done to detect hypoglycemia. Investigations revealed Hb 7.09 g/dl, WBC 12800/cmm, Platelet 98000/cmm, ALT 100 u/l, AST 110 u/l, LDH 1923 u/l, Retic. Count 4%, PT 16.5 sec. (control 14 sec.), urea 145 mg/dl, and Creatinine 3.5 mg/dl. Urinalysis showed presence of protein. Sinus tachycardia was noted on ECG. Ultrasound scan showed renal parenchymal changes with minimal ascites. The patient recovered with the above treatment and her level of consciousness improved within 24 hours. Glyceryl trinitrate infusion was replaced by oral amlodipine on the third day. The patient experienced no further fits. Urine output remained satisfactory. Her platelet count registered improvement within 24 hours and renal function did not show further deterioration. By the fifth day all parenteral treatment was stopped. Blood pressure remained well controlled on oral amlodipine and doxazocin. She was discharged from the hospital. Follow-up at 5th day was satisfactory. Liver function tests were normal, thrombocytopenia and renal function also normalized in another week. The antihypertensive therapy was also stopped after one month. Since then her blood pressure is well controlled on salt restriction alone.

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