OBJECTIVE: Our objective was to categorize the histologic findings in the liver 
in patients with HELLP syndrome (hemolysis, elevated liver enzymes, and low 
platelet count) and to correlate these findings with the severity of clinical 
laboratory abnormalities.
STUDY DESIGN: Eleven patients with laboratory criteria for HELLP syndrome who 
required cesarean delivery underwent needle biopsy of the liver under direct 
visualization.
RESULTS: Eight patients had periportal hemorrhage, and six had fibrin 
deposition. Fatty infiltration was seen in four, one with large-droplet fat, 
three with microvesicular fat. There was no statistically significant 
correlation between the severity of the histologic findings of periportal 
hemorrhage and fibrin deposition and the clinical laboratory findings. Fatty 
infiltration did not correlate with the severity of the HELLP syndrome's 
histologic condition, but, in contrast, did correlate with thrombocytopenia and 
aminotransferase elevations.
CONCLUSIONS: Laboratory abnormalities do not accurately reflect the severity of 
the underlying histopathologic condition in HELLP syndrome. We propose that all 
patients with HELLP syndrome, regardless of the degree of their laboratory 
abnormalities, be treated aggressively, primarily with delivery.