HELLP, MICROANGIOPATHIC HEMOLYTIC-ANEMIA, AND PREECLAMPSIA

Objective: The main question of the study concerns the specificity of the HELLP syndrome in the context of preeclampsia and other nonobstetric syndromes. Methods: The design of the study compares pathogenetic hypotheses and qualitative and quantitative alterations described for the HELLP syndrome, preeclampsia, and other microangiopathic nonobstetric syndromes. Main Outcome Measure(s): Data are collected to demonstrate that HELLP belongs to the family of microangiopathic diseases. Results: The HELLP syndrome is characterized by hemolysis, elevated liver enzymes, and low platelet count. Its place in the context of complicated pregnancies is still not clearly defined. An in-depth review of the literature shows that hematologic and pathologic findings assumed as typical of the HELLP syndrome are not qualitatively different from those reported to occur, although to a lesser extent, in preeclampsia. Microangiopathic hemolytic anemia (MHA), reflecting endothelial damage, is the cardinal sign of the syndrome, which shares this feature with many other nonobstetric syndromes characterized by the common background of endothelial damage. Conclusions: Following theoretical considerations and our experience in a nephrological setting, we propose that the HELLP syndrome not be set apart as a separate entity, because it belongs to the circulatory maladaptation syndrome of pregnancy which may be clinically expressed as preeclampsia, among which it is characterized by the severity of the associated microangiopathic hemolytic anemia.