DIFFERENTIAL-DIAGNOSIS OF HELLP-SYNDROME

The early detection of HELLP syndrome (hemolysis, elevated liver enzym es, and low platelets) is the basic condition for immediate therapeuti c management, which mainly leads to prompt delivery. The classical sym ptoms despite the typical laboratory evaluation (hemolysis, elevated L iver enzymes, low platelets) are epigastric or light upper quadrant pa in and nausea and vomiting: the classical signs of preeclampsia (prote inuria and hyper tension) may be absent in 20%. The differential diagn ostic problems of HELLP syndrome arise in relation to the mimikry-symp tomatic: upper abdomen pain can imitate gastroenterologic diseases (e. g. choleli thiasis, appendicitis), the elevated liver enzymes combined with hyper-bilirubinemia liver diseases (e.g. viral hepatitis) and th rombocytopenia in combination with hemolytic anemia, neurological symp toms and renal failure other similar pathogenetic disorders due to the category of thrombotic microangiopathies. Regarding the common sympto ms thrombocytopenia, hemolysis as well as signs of preeclampsia with o r without renal failure the differentiation from various autoimmune di seases also can be difficult in special cases. Rare first manifestatio ns and serious simultaneous diseases which can overlay the typical sig ns of HELLP syndrome show the variety of HELLP syndrome. Interdiscipli nary detours and delay are the consequences of this differential diagn ostic problems, which could imply deleterious effects on the mother an d the fetus, until the final diagnosis is clear. Therefore all pregnan t women with upper abdomen pain irrespective of symptoms of preeclamps ia should be considered to have HELLP syndrome and immediate laborator y evaluation has to be done, If there is any doubt a interdisciplinary , consultation is required!