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HELLP Syndrome — RACP Adult Medicine MCQ

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EasyGastroenterologyHELLP SyndromeRACP Adult Medicine

A 28-year-old woman at 35 weeks gestation presents with severe epigastric pain, nausea, and jaundice. BP 165/105 mmHg with 3+ proteinuria. Platelets 65 × 10⁹/L, ALT 550 U/L, LDH 850 U/L. Blood film shows schistocytes. Haptoglobin is undetectable. Bilirubin 80 μmol/L. What is the most likely diagnosis?

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Correct answer: D — HELLP syndrome

Explanation lettering: D = shown as B · E = shown as C · B = shown as D · C = shown as E

Hypertension, proteinuria, thrombocytopenia, elevated transaminases, elevated LDH, and microangiopathic haemolysis (schistocytes, low haptoglobin) in the third trimester is HELLP syndrome. It is a severe variant of pre-eclampsia with haemolysis (H), elevated liver enzymes (EL), and low platelets (LP). Class 1 HELLP (platelets <50) has the highest morbidity. Management: IV magnesium, BP control, urgent delivery (the only definitive treatment).

Reference: SOMANZ – 2023 – HELLP; ISSHP 2024