HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome: The benefit of corticosteroids

OBJECTIVE: The purpose of this study was to determine the effect of cortico steroids on platelet counts and liver functions in women with pregnancies c omplicated by the HELLP (hemolysis, elevated liver enzymes, and low platele ts) syndrome. STUDY DESIGN: The study group consisted of 93 patients between 24 and 34 we eks' gestation diagnosed with HELLP syndrome. All were given intramuscular injections of either betamethasone or dexamethasone. The 3 most common regi mens used were 12-mg of intramuscular betamethasone administered twice 12 h ours apart, 12 mg of intramuscular betamethasone administered twice 24 hour s apart, and 6 mg of intramuscular dexamethasone administered 4 times 6 hou rs apart. Precorticosteroid and postcorticosteroid platelet counts and live r function test results were compared. The differences in improvement in he matologic abnormalities among the 3 corticosteroid regimens were also analy zed. RESULTS: The hematologic abnormalities seen in the 93 patients with HELLP s yndrome improved after the administration of corticosteroids. The platelet count increased by 23.3 x 10(3)/mu L (P < .001). A statistically significan t decrease was seen in liver enzyme levels. The alanine aminotransferase de creased by 31.6 IU/L, the aspartate aminotransferase decreased by 52.1 IU/L , and the alkaline phosphatase decreased by 7.6 IU/L. Of the 3 regimens use d, 2 doses of 12 mg of intramuscular betamethasone given every 12 hours imp roved the liver function to the greatest degree. CONCLUSIONS: This study demonstrates that corticosteroids produce a signifi cant improvement in the hematologic abnormalities associated with HELLP syn drome. Two doses of betamethasone given 12 hours apart was the most effecti ve corticosteroid regimen.