Title:HELLP Syndrome Developing at 14 Weeks of Gestation: An Extremely
Rare Case Report and a Literature Review
Volume: 20
Issue: 6
Author(s): So Hee Park, Hayeon Kim, Jeong In Choi, Soo-Ho Chung and Jae Hong Sang*
Affiliation:
- Department of Obstetrics and Gynecology, Soonchunhyang University College of Medicine, Bucheon Hospital,
Bucheon, Korea
Keywords:
Anticardiolipin antibody IgM, antiphospholipid antibody, HELLP syndrome, hypertension, placenta, pregnancy.
Abstract:
Introduction: Hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome
is a disease of pregnancy that occurs very rarely before 20 weeks of gestation. We report a case of
HELLP syndrome developing at 14 weeks and 2 days of gestation.
Case Presentation: A 33-year-old Asian primipara at 14 weeks and 2 days of gestation visited the
emergency room with a fever and headache. Initial blood pressure was 140/70 mm Hg, temperature
38.5°C, heart rate 130 beats/min with tachycardia. Her prenatal examination has been unremarkable,
and fetal ultrasonography was within normal range. The laboratory results showed low
platelet count with elevated liver enzymes, D-dimer, and fibrinogen but no sign of jaundice. Her
WBC differential suggested a bacterial infection. Thus, we diagnosed early HELLP syndrome and
immediately started conservative treatments. One day after admission, symptoms and laboratory
results showed aggravation of the disease. We performed termination, followed by dilation and
curettage for retained placenta. Her general condition improved rapidly after the operation. Placental
biopsy showed both acute and chronic inflammation. She also had anticardiolipin antibody
IgM, and after discharge, she was referred to a rheumatology specialist to address the antiphospholipid
syndrome issue.
Discussion: Although the triggers of HELLP syndrome are unclear, a recent inflammatory hypothesis
suggests that placenta-derived inflammatory cytokines are involved. In our case, the anti-cardiolipin
antibody may have triggered microangiopathy of the placenta. Our analysis of published
HELLP cases revealed that, apart from the three diagnostic criteria, the most common abnormal
laboratory finding was antiphospholipid antibodies. Therefore, despite its rarity, if a sign of inflammation
is present in a patient, it is important to consider HELLP syndrome regardless of gestational
age.