A 28-year-old 35-week pregnant woman presents to the Emergency Department with acute onset epigastric pain. The biochemical profile and haematology report are as follows:
Parameter |
Result |
Normal Range |
Sodium |
138 mmol/L |
135 – 145 |
Potassium |
4.4 mmol/L |
3.2 –4.5 |
Chloride |
102 mmol/L |
100 – 110 |
Bicarbonate |
27 mmol/L |
22 – 27 |
Urea |
4.3 mmol/L |
3.0–8.0 |
Creatinine |
0.07 mmol/L |
0.07 – 0.12 |
Calcium |
2.35 mmol/L |
2.15 – 2.6 |
Corrected Calcium |
2.53 mmol/L |
2.15 – 2.8 |
Phosphate |
2.75 mmol/L* |
0.7 –1.4 |
Magnesium |
0.8 mmol/L |
0.7 –1.0 |
Glucose |
4.7 mmol/L |
3.6 –7.7 |
Albumin |
36 G/L |
33 – 47 |
CK |
71 U/L |
<160 |
Total Bilirubin |
40 micromol/L* |
4 – 20 |
GGT |
45 U/L |
0 – 50 |
ALP |
185 U/L* |
40 – 110 |
LDH |
748 U/L* |
110 – 250 |
AST |
241 U/L* |
<40 |
ALT |
189 U/L* |
<40 |
Haemoglobin |
88 G/L* |
110 – 160 |
White Cell Count |
12.4 x 109/L |
4.0 –15.0 |
Platelets |
64 x 109/L* |
150 – 400 |
The diagnosis and management of HELLP syndrome is well covered elsewhere.
The things to look for:
Thus, one would order the following tests:
Oh's Intensive Care manual: Chapter 63 (pp. 677) Preeclampsia and eclampsia by Wai Ka Ming and Tony Gin
Haram, Kjell, Einar Svendsen, and Ulrich Abildgaard. "The HELLP syndrome: clinical issues and management. A review." BMC pregnancy and childbirth 9.1 (2009): 8.