How should I manage a patient diagnosed with HELLP syndrome in a primary care setting before referral to secondary care?

Management of a patient diagnosed with HELLP syndrome in primary care before referral:

• Urgent referral to secondary care: HELLP syndrome is a severe complication of pre-eclampsia characterised by haemolysis, elevated liver enzymes, and low platelet count, requiring immediate hospital admission for specialist management. Refer the patient urgently to secondary care without delay NICE NG133.
• Initial assessment and monitoring: In primary care, perform a full clinical assessment including blood pressure measurement and review of symptoms such as right upper quadrant or epigastric pain, severe headache, visual disturbances, or signs of bleeding NICE NG133.
• Do not delay transfer: Do not attempt to manage HELLP syndrome definitively in primary care; stabilise the patient as much as possible and arrange rapid transfer to hospital for monitoring and treatment NICE NG133.
• Blood pressure control: If severe hypertension (≥160/110 mmHg) is present, and if trained and authorised, consider initial antihypertensive treatment (e.g., labetalol) to reduce risk of complications while awaiting transfer, but do not delay referral NICE NG133.
• Avoid invasive procedures: Avoid any invasive procedures or treatments that require specialist supervision in primary care.

Summary: The priority in primary care is urgent recognition, initial assessment, and immediate referral to secondary care for a patient with HELLP syndrome, as this condition requires specialist inpatient management NICE NG133.