"Beyond Preeclampsia: Atypical HELLP Syndrome Masquerading as Extensive Deep Vein Thrombosis"

Abstract

Pregnancy and the postpartum are known to have risk factors for venous thromboembolism (VTE). This is due to pregnancy being a prothrombotic state, exhibiting all components of Virchow's triad: venous stasis, endothelial damage, and hypercoagulability. HELLP (Hemolysis, Elevated Liver enzymes, and Low Platelets) syndrome is a severe and uncommon condition, usually secondary to preeclampsia. However, some cases, known as atypical HELLP syndrome, may not present with hypertension or may develop it very late. This report describes the case of a 23-year-old primigravida at 34 weeks and 6 days of gestation who presented with an acute episode of bilateral lower limb deep vein thrombosis (DVT) with superimposed atypical HELLP syndrome. The patient was managed with an emergency lower segment cesarean section with the placement of an Inferior Vena Cava (IVC) filter. Despite a complex postoperative course, her condition improved, and she was discharged sound and healthy, on postoperative day 23. This case highlights the complexity of managing DVT and atypical HELLP syndrome concurrently in a pregnant patient.