Case of Hemolysis, Elevated Liver Enzymes, and Low Platelet Count (HELLP) Syndrome Complicated by Sepsis: Challenges in Diagnosis and Management

Hemolysis, Elevated Liver Enzymes, and Low Platelet Count (HELLP) syndrome, complicated by sepsis, is a rare yet highly lethal obstetric emergency characterized by synergistic endothelial dysfunction and coagulopathy. This condition presents significant diagnostic difficulties because of its similarities with severe preeclampsia and unusual sepsis. We present the case of a 30-year-old primigravida at 28 weeks’ gestation. She was hospitalized for oligohydramnios and mild hypertension, but quickly progressed to experiencing severe epigastric pain, fever, and multiorgan failure. Laboratory tests revealed thrombocytopenia (51 × 10⁹/L), microangiopathic hemolysis with schistocytes, hepatitis (aspartate aminotransferase 995 U/L), and hyperinflammation (interleukin-6 >500 pg/mL, procalcitonin 35.3 ng/mL). HELLP syndrome was confirmed after the exclusion of other thrombotic microangiopathies. Sepsis preceded the development of HELLP syndrome, with Klebsiella pneumoniae bacteremia and influenza A infection identified as the primary etiologies of sepsis. The multidisciplinary management involved emergent cesarean delivery, broad-spectrum antibiotics, plasma transfusion, and immunomodulation, resulting in progressive maternal recovery and neonatal survival despite premature birth. This case highlights the crucial importance of prompt sepsis screening in HELLP patients experiencing swift clinical decline. It also emphasizes the significance of protocolized interventions guided by Sequential Organ Failure Assessment and coordinated multidisciplinary efforts to reduce the combined risks of maternal-fetal mortality.