Key messages

• The hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome can be considered an additional criterion of pre-eclampsia.

• The etiology is unknown and is often observed in the absence of pre-eclampsia. An endothelial cell abnormality is thought to lead to fibrin deposition, secondary consumptive thrombocytopenia, and microangiopathic hemolysis.

• The platelet count separates the patients into two classes of severity: class 1 (< 50^10 9/l) and class 2 ((50-100)*109/l).

• Clinical presentation is non-specific and includes malaise, right upper quadrant or epigastric pain, nausea, edema, headaches, and hypertension.

• Liver intraparenchymal and subcapsular hematoma are the most feared complications because of the risk of hepatic rupture.

• Prompt recognition by laboratory investigations and exclusion of hepatic complications are mandatory in order to reduce maternal morbidity.

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