Key Takeaways

✅ Thrombocytopenia in pregnancy may be caused by pregnancy-specific and non-pregnancy specific conditions.

✅ Concomitant presence of thrombocytopenia and macroangiopathic hemolytic anemia raises concern for an underlying thrombotic microangiopathy, including HELLP, TTP, HUS or AFLP.

✅ HELLP is a variant of severe preeclampsia.

✅ Suspect a diagnosis of HELLP in a patient with TMA who has:

• Hypertension and proteinuria
• Abnormal liver function tests
• Normal prothrombin time (elevated in AFLP)
• Absence of hypoglycemia (characteristic of AFLP)

✅ Confirm diagnosis of HELLP using one of several classification schemes:

• American College of Obstetricians and Gynecologists
• Tennessee Classification System
• Mississippi Triple-Class System

✅ Treat HELLP with supportive care and delivery within 48 h of presentation.