A pregnant woman at 32 weeks gestation presents with abdominal pain, nausea, vomiting, and malaise. She has mid-epigastric and right upper quadrant tenderness. Exam shows blood pressure 150/90 and proteinuria. Labs show platelets at 80,000, serum LDH 800, total bilirubin 2.0, and serum AST 120.Challenge: What is your diagnosis?
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HELLP syndrome?
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As the title suggests, this is HELLP syndrome characterized by a microangiopathic hemolytic anemia (seen in the peripheral blood smear), elevated liver enzymes, and a low platelet count. The cornerstone of therapy is delivery.
Sources: UpToDate, image originally courtesy of Carola von Kapff.
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