Evidence of elevated C-reactive protein (CRP) in HELLP-syndrome

Purpose: Hemolysis, elevated liver enzymes combined with a low platelet count are known as an atypical form of preeclampsia and commonly refered to as HELLP Syndrome. The laboratory trias is characteristic in most cases, but the diagnosis may be difficult in patients without these typical laboratory findings. Material and Method: In our retrospective study on 46 women with a HELLP-syndrome, serum concentrations of the C-reactive protein (CRP) were analysed. Only CRP-concentrations measured immediately before delivery were evaluated. Both patients with antepartum and postpartum laboratory evidence of HELLP-syndrome were included. Results: In 30 of 46 women (65%) with laboratory evidence of HELLP-syndrome the CRP-concentrations were above 12 mg/l, presenting the upperlimit of the normal range during pregnancy. The median value was 23 mg/l, with 98 mg/l being the maximum value measured in one patient. Increasing serum concentrations of CRP were correlated with low platelet counts (p = 0.02). There was no correlation between the CRP levels and the enzyme activities of AST and LDH. There was also no significant correlation between the conventional parameters platelet count and AST levels, demonstrating the heterogeneity of laboratory findings in HELLP-syndrome. Conclusion: Thus, elevated CRP-levels may supplement the diagnostic parameters in cases of suspected HELLP-syndrome. On the other hand, abnormal concentrations of CRP do not point to an infectious disease in patients with a HELLP-syndrome.