{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T07:44:53Z","timestamp":1761896693241,"version":"build-2065373602"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T00:00:00Z","timestamp":1761868800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Thrombotic disseminated intravascular coagulation (DIC) associated with hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome in the absence of typical hypertension is rare, and its pathogenesis differs significantly from that of hemorrhagic DIC. Although the overall incidence is low, disease progression is often rapid and carries a high risk of multi-organ failure. Pregnancy-specific physiologic changes, including endothelial injury, hypercoagulability, and a predisposition to microcirculatory thrombosis, markedly increase the likelihood of microangiopathic coagulation activation in non-hypertensive HELLP patients. Therefore, prompt recognition of coagulation abnormalities and timely, targeted interventions are crucial for improving patient outcomes. Here, we report a case of HELLP syndrome without prenatal hypertension that rapidly progressed to DIC and acute kidney injury (AKI), despite only moderate blood loss (800\u202fmL). This case highlights potential mechanisms underlying microangiopathic coagulation activation and provides an important reference for the clinical recognition and management of such occult coagulopathies.<\/jats:p>","DOI":"10.3389\/fmed.2025.1641271","type":"journal-article","created":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T06:24:49Z","timestamp":1761891889000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: A rare complication of non-hypertensive HELLP syndrome\u2014microangiopathic coagulation activation leading to postpartum DIC with acute kidney injury"],"prefix":"10.3389","volume":"12","author":[{"given":"Chunping","family":"Li","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianping","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yong","family":"Tang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,31]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"70","DOI":"10.7754\/Clin.Lab.2024.231228","article-title":"Maternal and fetal outcomes in disseminated intravascular coagulation cases associated with pregnancy complications","volume":"70","author":"Oguz","year":"2024","journal-title":"Clin Lab"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"666014","DOI":"10.3389\/fonc.2021.666014","article-title":"Case Report: ANXA2 associated life-threatening coagulopathy with hyperfibrinolysis in a patient with non-APL acute myeloid leukemia","volume":"11","author":"Ruhnke","year":"2021","journal-title":"Front Oncol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"10760296241271358","DOI":"10.1177\/10760296241271358","article-title":"Exploring the mediating role of multiple organ dysfunction in Sepsis-induced disseminated intravascular coagulation and its impact on worsening prognosis","volume":"30","author":"Wang","year":"2024","journal-title":"Clin Appl Thromb Hemost"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"20220016","DOI":"10.1515\/crpm-2022-0016","article-title":"Pregnancy associated atypical hemolytic uremic syndrome presenting with preeclampsia with HELLP syndrome and following treatment with eculizumab","volume":"12","author":"Gunawan","year":"2023","journal-title":"Case Rep Perinat Med"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"e19798","DOI":"10.1097\/MD.0000000000019798","article-title":"Clinical characteristics and pregnancy outcomes of atypical hemolysis, elevated liver enzymes, and low platelets syndrome: a case series","volume":"99","author":"Jiang","year":"2020","journal-title":"Medicine"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1016\/j.preghy.2018.02.007","article-title":"Thrombotic microangiopathies of pregnancy: differential diagnosis","volume":"12","author":"Gupta","year":"2018","journal-title":"Pregnancy Hypertens"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"3259","DOI":"10.1080\/14767058.2020.1818200","article-title":"Placental abruption as a trigger of DIC in women with HELLP syndrome: a population-based study","volume":"35","author":"Gomez-Tolub","year":"2022","journal-title":"J Matern Fetal Neonatal Med"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"342","DOI":"10.1111\/imj.14337","article-title":"Diagnosis and management of pregnancies complicated by haemolysis, elevated liver enzymes and low platelets syndrome in the tertiary setting","volume":"50","author":"Jayawardena","year":"2020","journal-title":"Intern Med J"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"136","DOI":"10.4103\/IJCIIS.IJCIIS_33_17","article-title":"Intensive care unit issues in eclampsia and HELLP syndrome","volume":"7","author":"Lam","year":"2017","journal-title":"Int J Crit Illn Inj Sci"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"816","DOI":"10.2174\/1389201019666180712115215","article-title":"HELLP syndrome: pathophysiology and current therapies","volume":"19","author":"Wallace","year":"2018","journal-title":"Curr Pharm Biotechnol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"e237","DOI":"10.1097\/AOG.0000000000003891","article-title":"Gestational hypertension and preeclampsia: ACOG practice bulletin, number 222","volume":"135","year":"2020","journal-title":"Obstet Gynecol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"511","DOI":"10.1097\/OGX.0000000000000197","article-title":"Amniotic fluid embolism: anaphylactic reactions with idiosyncratic adverse response","volume":"70","author":"Kobayashi","year":"2015","journal-title":"Obstet Gynecol Surv"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"623","DOI":"10.1093\/bja\/aeu444","article-title":"Pre-emptive treatment with fibrinogen concentrate for postpartum haemorrhage: randomized controlled trial","volume":"114","author":"Wikkels\u00f8","year":"2015","journal-title":"Br J Anaesth"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"633","DOI":"10.1007\/s12185-025-03918-0","article-title":"Clinical practice guidelines for management of disseminated intravascular coagulation in Japan 2024: part 4-trauma, burn, obstetrics, acute pancreatitis\/liver failure, and others","volume":"121","author":"Hayakawa","year":"2025","journal-title":"Int J Hematol"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1186\/s13613-018-0402-x","article-title":"Principles of fluid management and stewardship in septic shock: it is time to consider the four D\u2019s and the four phases of fluid therapy","volume":"8","author":"Malbrain","year":"2018","journal-title":"Ann Intensive Care"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1038\/s41419-020-2298-2","article-title":"Ferroptosis: past, present and future","volume":"11","author":"Li","year":"2020","journal-title":"Cell Death Dis"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1186\/s13293-020-00331-6","article-title":"Acute kidney injury during pregnancy leads to increased sFlt-1 and sEng and decreased renal T regulatory cells in pregnant rats with HELLP syndrome","volume":"11","author":"Szczepanski","year":"2020","journal-title":"Biol Sex Differ"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"2190","DOI":"10.1001\/jama.2016.5828","article-title":"Effect of early vs. delayed initiation of renal replacement therapy on mortality in critically ill patients with acute kidney injury: the ELAIN randomized clinical trial","volume":"315","author":"Zarbock","year":"2016","journal-title":"JAMA"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1506","DOI":"10.1016\/S0140-6736(20)30531-6","article-title":"Delayed versus early initiation of renal replacement therapy for severe acute kidney injury: a systematic review and individual patient data meta-analysis of randomised clinical trials","volume":"395","author":"Gaudry","year":"2020","journal-title":"Lancet"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"4796","DOI":"10.1093\/rheumatology\/keaf204","article-title":"Anti-\u03b22glycoprotein I-induced neutrophil extracellular traps cause endothelial activation","volume":"64","author":"Mancuso","year":"2025","journal-title":"Rheumatology (Oxford)"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1641271\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T06:25:06Z","timestamp":1761891906000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1641271\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,31]]},"references-count":20,"alternative-id":["10.3389\/fmed.2025.1641271"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1641271","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,31]]},"article-number":"1641271"}}