HELLP syndrome may lead to
disseminated intravascular coagulation (
DIC) which can make emergency surgery a serious challenge. A 29-year-old female presented with haematuria,
epistaxis and
hypertension in the emergency ward and a diagnosis of
DIC complicating HELLP in
preeclampsia was made. She had continuous
epistaxis and elective tracheal intubation was carried out. During emergency
caesarean section the patient was managed with blood products,
antihypertensive drugs and general anaesthesia together with invasive monitoring. She required postoperative ventilatory support.
HELLP syndrome may progress to
DIC in 15-38% of patients. The prothrombin time, activated partial thromboplastin time and serum
fibrinogen levels are normal in
HELLP syndrome but are prolonged in
DIC. Evaluation of more sensitive markers of
DIC, such as
antithrombin III, α-2
antiplasmin, plasminogens,
fibrin monomer and D-dimers, differentiates
DIC from
HELLP syndrome. Aggressive treatment is indicated and delivery should be expedited, by
caesarean section if necessary although vaginal delivery is not contraindicated, along with control of blood pressure and coagulation abnormality. We conclude that patients with
DIC complicating
HELLP syndrome and
preeclampsia require great vigilance and multimodal management in the
perioperative period for uneventful outcome.