{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T09:09:25Z","timestamp":1784365765610,"version":"3.55.0"},"reference-count":11,"publisher":"BMJ","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ Case Reports"],"published-print":{"date-parts":[[2009]]},"abstract":"<jats:p>HELLP syndrome may lead to disseminated intravascular coagulation (DIC) which can make emergency surgery a serious challenge. A 29-year-old female presented with haematuria, epistaxis and hypertension in the emergency ward and a diagnosis of DIC complicating HELLP in preeclampsia was made. She had continuous epistaxis and elective tracheal intubation was carried out. During emergency caesarean section the patient was managed with blood products, antihypertensive drugs and general anaesthesia together with invasive monitoring. She required postoperative ventilatory support. HELLP syndrome may progress to DIC in 15\u201338% of patients. The prothrombin time, activated partial thromboplastin time and serum fibrinogen levels are normal in HELLP syndrome but are prolonged in DIC. Evaluation of more sensitive markers of DIC, such as antithrombin III, \u03b1-2 antiplasmin, plasminogens, fibrin monomer and D-dimers, differentiates DIC from HELLP syndrome. Aggressive treatment is indicated and delivery should be expedited, by caesarean section if necessary although vaginal delivery is not contraindicated, along with control of blood pressure and coagulation abnormality. We conclude that patients with DIC complicating HELLP syndrome and preeclampsia require great vigilance and multimodal management in the perioperative period for uneventful outcome.<\/jats:p>","DOI":"10.1136\/bcr.10.2008.1027","type":"journal-article","created":{"date-parts":[[2009,4,17]],"date-time":"2009-04-17T12:47:32Z","timestamp":1239972452000},"page":"bcr1020081027","source":"Crossref","is-referenced-by-count":9,"title":["Disseminated intravascular coagulation complicating HELLP syndrome: perioperative management"],"prefix":"10.1136","volume":"2009","author":[{"given":"Rakesh","family":"Garg","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M P","family":"Nath","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A P","family":"Bhalla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashwani","family":"Kumar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2009,4,17]]},"reference":[{"key":"2025042507471270000_2009.apr16_1.bcr1020081027.1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/74.4.464"},{"key":"2025042507471270000_2009.apr16_1.bcr1020081027.2","first-page":"419","article-title":"HELLP syndrome \u00e2\u0080\u0093 a multisystemic disorder","volume":"16","author":"Mihu","year":"2007","journal-title":"J Gastrointestin Liver Dis"},{"key":"2025042507471270000_2009.apr16_1.bcr1020081027.3","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1590\/S1516-31802006000200007","article-title":"Maternal outcome in HELLP syndrome requiring intensive care management in a Turkish hospital","volume":"124","author":"Osmanagaoglu","year":"2006","journal-title":"Sao Paulo Med J"},{"key":"2025042507471270000_2009.apr16_1.bcr1020081027.4","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1016\/S0002-9378(99)70343-1","article-title":"Maternal mortality associated with HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome","volume":"181","author":"Isler","year":"1999","journal-title":"Am J Obstet Gynecol"},{"key":"2025042507471270000_2009.apr16_1.bcr1020081027.5","first-page":"40","article-title":"Diagnosis and management of women with hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome","volume":"49","author":"Witlin","year":"1999","journal-title":"Hospital Physician"},{"key":"2025042507471270000_2009.apr16_1.bcr1020081027.6","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2000.105915"},{"key":"2025042507471270000_2009.apr16_1.bcr1020081027.7","first-page":"510","article-title":"Morbidity regularity of severe complications of hypertensive disorder complicating pregnancy in clinics","volume":"42","author":"Wan","year":"2007","journal-title":"Zhonghua Fu Chan Ke Za Zhi"},{"key":"2025042507471270000_2009.apr16_1.bcr1020081027.8","doi-asserted-by":"publisher","DOI":"10.1097\/00004836-199906000-00008"},{"key":"2025042507471270000_2009.apr16_1.bcr1020081027.9","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1097\/01.AOG.0000126245.35811.2a","article-title":"Diagnosis, controversies, and management of the syndrome of hemolysis, elevated liver enzymes, and low platelet count","volume":"103","author":"Sibai","year":"2004","journal-title":"Obstet Gynecol"},{"key":"2025042507471270000_2009.apr16_1.bcr1020081027.10","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1097\/00007611-199504000-00006","article-title":"D-dimer test for early detection of HELLP syndrome","volume":"88","author":"Neiger","year":"1995","journal-title":"South Med J"},{"key":"2025042507471270000_2009.apr16_1.bcr1020081027.11","doi-asserted-by":"crossref","first-page":"1167","DOI":"10.1016\/S0025-7125(05)70484-3","article-title":"Liver disease in pregnancy","volume":"80","author":"Wolf","year":"1996","journal-title":"Med Clin North Am"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr.10.2008.1027","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,25]],"date-time":"2025-04-25T14:47:17Z","timestamp":1745592437000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr.10.2008.1027"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009]]},"references-count":11,"alternative-id":["10.1136\/bcr.10.2008.1027"],"URL":"https:\/\/doi.org\/10.1136\/bcr.10.2008.1027","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2009]]}}}