Hemolysis, Elevated Liver Enzymes and Low Platelets (HELLP) Syndrome and Metastatic Breast Cancer: A Rare Overlap in a Postpartum Patient With Disseminated Intravascular Coagulation and Refractory Thrombocytopenia

Abstract

A middle-aged female arrived at a tertiary care hospital after a referral from her primary care physician to evaluate a left breast mass found on ultrasound concerning malignancy. The patient was also 27 weeks gestational with monochorionic diamniotic twins. During triage, she was found to have severe hypertension and lab abnormalities concerning HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome and underwent cesarean delivery of the infants. She had a biopsy of the left breast mass post-delivery, later diagnosed as invasive ductal cell carcinoma with spinal metastasis and numerous metastatic pulmonary nodules. Her hospital stay was complicated by a right lower extremity deep vein thrombosis, acute subdural hematoma, and disseminated intravascular coagulation with refractory thrombocytopenia resulting in her death.

Keywords: acute subdural hematoma; deep vein thrombosis (dvt); disseminated intravascular coagulation; hellp syndrome; metastatic breast cancer; refractory thrombocytopenia.