HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) presenting as generalized malaise

The syndrome of hemolysis, elevated liver enzymes, and low platelet count (HELLP) was first described by Weinstein in 1982 and is generally thought to represent a variant of the preeclampsia-eclampsia syndrome. As with other severe manifestations of preeclampsia-eclampsia, epigastric pain and liver tenderness are commonly recognized presenting symptoms of this syndrome, but an underappreciated presenting symptom is generalized malaise or symptoms similar to a flulike syndrome. Two case examples, a review of one private hospitalʹs recent cases, and data contained in the literature are presented to stress the importance of malaise as a presenting complaint during late pregnancy, with recommendations for screening these patients.