What laboratory investigations are essential for confirming a diagnosis of HELLP syndrome?

Essential laboratory investigations for confirming a diagnosis of HELLP syndrome include:

• Full blood count to identify thrombocytopenia (platelet count typically <100 x 10^9/L).
• Peripheral blood smear to detect microangiopathic hemolytic anemia evidenced by schistocytes.
• Liver function tests showing elevated liver enzymes, particularly aspartate aminotransferase (AST) and alanine aminotransferase (ALT), often >70 IU/L.
• Lactate dehydrogenase (LDH) levels elevated, reflecting hemolysis and liver injury, usually >600 IU/L.
• Serum bilirubin to assess hemolysis, often mildly elevated.
• Coagulation profile to exclude disseminated intravascular coagulation, although not diagnostic for HELLP itself.

These investigations collectively confirm the triad of hemolysis, elevated liver enzymes, and low platelets characteristic of HELLP syndrome ¹ (Barton and Sibai, 2004). Differentiation from other pregnancy-related liver disorders such as acute fatty liver of pregnancy may require additional tests but the above remain central to diagnosis ¹ (Minakami et al., 2014). Early and accurate laboratory confirmation is critical for timely management and improved maternal-fetal outcomes ¹ (Magann et al., 1994).