Classic and Atypical HELLP Syndrome: Report of Two Cases and Clinical Considerations
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Keywords
HELLP Syndrome, Pregnancy, Preeclampsia, Maternal Morbidity, Thrombocytopenia
Abstract
HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count) is one of the most severe complications of hypertensive disorders of pregnancy and is associated with high maternal and perinatal morbidity and mortality. The coexistence of classic and atypical presentations may hinder timely diagnosis and delay appropriate management. Objective: To describe and compare two cases of HELLP syndrome—one classic and one atypical—highlighting their clinical and biochemical differences as well as the main maternal and perinatal outcomes. Case presentation: Two pregnant women managed at a high-complexity referral center are reported. The first case corresponded to classic HELLP syndrome, characterized by marked thrombocytopenia, significant elevation of liver enzymes, and clinical evidence of hemolysis. The second case presented as atypical HELLP syndrome, with incomplete manifestations and an initial clinical course overlapping with preeclampsia. In both cases, relevant maternal complications were documented, including eclampsia, hepatic dysfunction, and the need for blood product transfusion, as well as adverse perinatal outcomes such as prematurity. Pregnancy termination was the main therapeutic intervention. Conclusion: HELLP syndrome may present with variable clinical spectra that require a high index of diagnostic suspicion. Early recognition, particularly of atypical forms, together with multidisciplinary management in specialized centers, is essential to reduce maternal–fetal morbidity and mortality.
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