A case of atypical HELLP (haemolysis, elevated liver enzymes and low platelet count) syndrome presenting as bleeding from the epidural puncture site during labour

Summary HELLP (haemolysis, elevated liver enzymes and low platelet count) syndrome has been recognised as a life threatening complication of pregnant women for many years. The majority of women with HELLP syndrome have hypertension and proteinuria which may be absent in 10–20% of cases–referred to as atypical HELLP. A primigravida received epidural labour analgesia and she continued to bleed from the skin puncture site. Evaluation for the cause of bleed established the diagnosis of atypical HELLP syndrome. Although rarely encountered, an atypical HELLP may have dangerous anaesthetic consequences when clinicians are caught unawares. We report one such case with atypical presentation.