Thrombocytopenia with the HELLP syndrome. Report of two cases with reversal in normotensive and nonproteinuric gravidas.
BACKGROUND
In the absence of hypertension and proteinuria, pregnant women with hemolysis, elevated liver enzymes and low platelet count (HELLP syndrome) present a diagnostic and therapeutic problem.


METHODS
Two atypical cases occurred of HELLP syndrome diagnosed by hemolysis, elevated liver enzymes and low platelet count. The patients presented early in the third trimester with epigastric pain and lacked the usual signs of preeclampsia, such as hypertension and proteinuria. The patients were managed expectantly; during this time they became hypertensive, but the thrombocytopenia resolved.


CONCLUSIONS
Pregnant women with hemolysis, elevated liver enzymes and thrombocytopenia who do not have hypertension or proteinuria should undergo complete diagnostic evaluation. If other etiologies are ruled out, the patient should be managed as appropriate for severe preeclampsia complicated by the HELLP syndrome.
Segal
S
S
Department of Obstetrics and Gynecology, Barzilai Medical Center, Ashkelon, Israel.
Shenhav
S
S
Gemer
O
O
D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D017359:HELLP Syndrome / Q000175:diagnosis*; D006801:Humans; D010976:Platelet Count; D011247:Pregnancy; D011256:Pregnancy Outcome; D013921:Thrombocytopenia / Q000150:complications*