Differentiating preeclampsia from thrombotic thrombocytopenic purpura (TTP) syndrome with hemolysis, high liver enzymes, and low platelet count (HELLP) syndrome can be difficult.

Researchers discuss the case of a 34-year-old lady, G1P0, who came with a new-onset hazy vision, hypertension, and a platelet count of 4×109/L. Despite overlapping TTP-related characteristics, an unusual HELLP syndrome diagnosis was obtained following a multidisciplinary debate. Her platelet count and ADAMTS13 activity tests revealed that she recovered normally after delivery without the use of plasma exchange treatment, confirming the diagnosis of HELLP syndrome. 

Hemolysis, increased liver enzymes, and low platelet count syndrome can all cause severe thrombocytopenia and ADAMTS13 activity deficit in levels that are normally associated with TTP.