A Rare Case of Hemolysis, Elevated Liver Enzymes, and Low Platelets Syndrome Causing Acute Pancreatitis
Jayalakshmi M Manjunath
Keywords :
Case report, Hemolysis, elevated liver enzymes, and low platelets syndrome, Pain abdomen, Pancreatitis, Pregnancy
Citation Information :
Manjunath JM. A Rare Case of Hemolysis, Elevated Liver Enzymes, and Low Platelets Syndrome Causing Acute Pancreatitis. 2023; 2 (2):74-76.
Most cases of acute pancreatitis (AP) in pregnancy are attributed to gallstones. The hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome causing AP is very rare. This is a case of a 26-year-old female who had a normal delivery 2 days back following a full-term pregnancy complicated with preeclampsia (PE). She presented to our hospital with a history of pain abdomen, fever, and vomiting for 2 days. She had PE for which she was treated with tablets aspirin and labetalol. Routine investigations revealed thrombocytopenia, hemolysis, elevated alanine aminotransferase (ALT), and aspartate aminotransferase (AST) suggestive of HELLP syndrome. Blood investigation revealed elevated serum amylase and lipase levels along with computed tomography (CT) of the abdomen suggestive of AP. She was diagnosed to be having HELLP syndrome-associated AP and was managed conservatively. The patient's condition and lab parameters improved gradually and discharged home in stable condition. This case report highlights a rare case of HELLP syndrome causing AP.
Singh VK, Bollen TL, Wu BU, et al. An assessment of the severity of interstitial pancreatitis. Clin Gastroenterol Hepatol 2011;9(12):1098–1103. DOI: 10.1016/j.cgh.2011.08.026
Van Santvoort HC, Bakker OJ, Bollen TL, et al. A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome. Gastroenterology 2011;141(4):1254–1263. DOI: 10.1053/j.gastro.2011.06.073
Abildgaard U, Heimdal K. Pathogenesis of the syndrome of hemolysis, elevated liver enzymes, and low platelet count (HELLP): a review. Eur J Obstet Gynecol Reprod Biol 2013;166(2):117–123. DOI: 10.1016/j.ejogrb.2012.09.026
Kawatani Y, Kurobe H, Nakamura Y, et al. Acute pancreatitis caused by pancreatic ischemia after TEVAR combined with intentional celiac artery coverage and embolization of the branches of the celiac artery. J Surg Case Rep 2017;2017(2):rjx029. DOI: 10.1093/jscr/rjx029
Gullo LU, Cavicchi LO, Tomassetti PA, et al. Effects of ischemia on the human pancreas. Gastroenterology 1996;111(4):1033–1038. DOI: 10.1016/s0016-5085(96)70072-0
Roberts JM, August PA, Bakris G. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on hypertension in pregnancy. Obstet Gynecol 2013;122(5):1122– 1131. DOI: 10.1097/01.AOG.0000437382.03963.88
Rao D, Chaudhari NK, Moore RM, et al. HELLP syndrome: a diagnostic conundrum with severe complications. BMJ Case Rep 2016;17(1):1–5. DOI: 10.1136/bcr-2016-216802
Ospina-Tascón GA, Calvache AJ, Quiñones E, et al. Microcirculatory blood flow derangements during severe preeclampsia and HELLP syndrome. Pregnancy Hypertens 2017;10(1):124–130. DOI: 10.1016/j.preghy.2017.07.140
Ananth CV, Keyes KM, Wapner RJ. Pre-eclampsia rates in the United States, 1980-2010: ageperiod-cohort analysis. BMJ 2013;347:f6564. DOI: 10.1136/bmj.f6564
Swank M, Nageotte M, Hatfield T. Necrotizing pancreatitis associated with severe preeclampsia. Obstet Gynecol 2012;120(2):453–455. DOI: 10.1097/AOG.0b013e31824fc617
Sang C, Wang S, Zhang Z, et al. Characteristics and outcome of severe preeclampsia/eclampsia concurrent with or complicated by acute pancreatitis: a report of five cases and literature review. J Matern Fetal Neonatal Med 2019;35(4):633–640. DOI: 10.1080/14767058.2017.1387894
Gainder S, Arora P, Saha SC, et al. Acute pancreatitis with eclampsia-preeclampsia syndrome and poor maternal outcome: two case reports and review of literature. Obstet Med 2015;8(3):146–148. DOI: 10.1177/1753495X15585257
O'Brien JM, Pursell N, Fumia F. Pancreatic and colonic abscess formation secondary to HELLP syndrome. Case Rep Obstet Gynecol 2015;2015:165435. DOI: 10.1155/2015/165435
Hojo S, Tsukimori K, Hanaoka M, et al. Acute pancreatitis and cholecystitis associated with postpartum HELLP syndrome: a case and review. Hypertens Pregnancy 2007;26(1):23–29. DOI: 10.1080/10641950601146491
