The diagnosis of HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count) is based upon the presence of the characteristic laboratory findings in patients of appropriate gestational age. Imaging tests, particularly CT or MRI scanning, are useful when complications such as hepatic infarction, hematoma, or rupture are suspected.

The diagnosis is established by the presence of preeclampsia and the following criteria:

• Microangiopathic hemolytic anemia with characteristic schistocytes on blood smear

• Platelet count <100,000 cells/µL

• Serum lactate dehydrogenase >600 IU/L or total bilirubin >1.2 mg/dL

• Serum aspartate aminotransferase (AST) >70 IU/L

References:

1. Sibai BM, Ramadan MK, Usta I, Salama M, Mercer BM, Friedman SA. Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome) Am. J. Obstet. Gynecol. 1993 Oct;169(4):1000-6. [Medline]

2. Barton JR, Riely CA, Adamec TA, Shanklin DR, Khoury AD, Sibai BM. Hepatic histopathologic condition does not correlate with laboratory abnormalities in HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count) Am. J. Obstet. Gynecol. 1992 Dec;167(6):1538-43. [Medline]