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.

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