HELLP syndrome and the anaesthetist.

Four pregnant patients are described who had varying signs of pre-eclampsia plus haemolysis, elevated liver enzymes and a low platelet count. Two of the patients presented without hypertension and all posed considerable diagnostic difficulties, with problems in clinical management. Pregnancy induced hypertension is only one manifestation of a much more diverse pathophysiological process. Anaesthetists need to be aware of these other pregnancy related disorders in order to avoid diagnostic pitfalls and to enable them to provide safely the appropriate general and regional anaesthetic techniques.