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Correct diagnosis may have implications for maternal morbidity and mortality, risk of recurrence, risk to the child, and the risk of long-term maternal disease. The Swansea criteria lack specificity, a significant proportion of women with HELLP fulfilling criteria. Low antithrombin III, elevated circulating soluble Fms-like tyrosine kinase-1, hypocholesterolaemia, hypofibrinogenaemia, and reduced portal vein blood flow velocity have been proposed as differentiating AFLP from HELLP. A case of presumed AFLP associated with hypocholesterolaemia is presented, and the literature regarding markers in the differentiation of AFLP from HELLP is discussed. Hypocholesterolaemia may be useful in differentiating between AFLP and HELLP syndrome, particularly in resource-limited settings.<\/jats:p>","DOI":"10.1177\/1753495x261431266","type":"journal-article","created":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T08:35:40Z","timestamp":1773650140000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Hypocholesterolaemia as an early feature of presumed acute fatty liver of pregnancy"],"prefix":"10.1177","author":[{"given":"Nik Nur Iman","family":"Nik Ghazali","sequence":"first","affiliation":[{"name":"Department of Obstetric Medicine, Mater Hospital Brisbane"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0437-1680","authenticated-orcid":false,"given":"Julian","family":"Pavey","sequence":"additional","affiliation":[{"name":"Department of Obstetric Medicine, Mater Hospital Brisbane"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9887-714X","authenticated-orcid":false,"given":"Adam","family":"Morton","sequence":"additional","affiliation":[{"name":"Department of Obstetric Medicine, Mater Hospital Brisbane"},{"name":"Department of Medicine, University of Queensland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,3,16]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1136\/gut.51.6.876"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.3109\/14767058.2013.773308"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2017.54"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1177\/1753495X18759353"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.15137"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0168-8278(20)32012-2"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1002\/hep.31144"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0020-7292(01)00364-2"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1080\/14767058.2020.1754790"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.14218"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.121.17258"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2024.1506340"},{"key":"e_1_3_2_14_2","first-page":"624","article-title":"A comparison of clinical characteristics between acute fatty liver of pregnancy and hemolysis, elevated liver enzymes and low platelets syndrome","volume":"34","author":"Dai D","year":"2022","unstructured":"Dai D, Tang S, Xu W, et al. 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