Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Essential laboratory investigations for confirming a diagnosis of HELLP syndrome include:
- Full blood count to identify thrombocytopenia (platelet count typically <100 x 10^9/L).
- Peripheral blood smear to detect microangiopathic hemolytic anemia evidenced by schistocytes.
- Liver function tests showing elevated liver enzymes, particularly aspartate aminotransferase (AST) and alanine aminotransferase (ALT), often >70 IU/L.
- Lactate dehydrogenase (LDH) levels elevated, reflecting hemolysis and liver injury, usually >600 IU/L.
- Serum bilirubin to assess hemolysis, often mildly elevated.
- Coagulation profile to exclude disseminated intravascular coagulation, although not diagnostic for HELLP itself.
These investigations collectively confirm the triad of hemolysis, elevated liver enzymes, and low platelets characteristic of HELLP syndrome NICE NG133 Barton & Sibai 2004. Differentiation from other pregnancy-related liver disorders such as acute fatty liver of pregnancy may require additional tests but the above remain central to diagnosis NICE NG133 Minakami et al. 2014. Early and accurate laboratory confirmation is critical for timely management and improved maternal-fetal outcomes NICE NG133 Magann et al. 1994.
Key References
- NG133 - Hypertension in pregnancy: diagnosis and management
- NG126 - Ectopic pregnancy and miscarriage: diagnosis and initial management
- NG88 - Heavy menstrual bleeding: assessment and management
- NG95 - Lyme disease
- (Magann et al., 1994): Antepartum corticosteroids: disease stabilization in patients with the syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP).
- (Barton and Sibai, 2004): Diagnosis and management of hemolysis, elevated liver enzymes, and low platelets syndrome.
- (Minakami et al., 2014): Differentiation of acute fatty liver of pregnancy from syndrome of hemolysis, elevated liver enzymes and low platelet counts.