Jaundice and oliguria in hellp syndrome with low complement c3 levels: a forgotten entity

HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelet count) is a severe complication of pre-eclampsia. Atypical hemolytic uremic syndrome rarely presents during pregnancy and is characterized by low C3 complement levels. Low complement levels are also observed in HELLP syndrome and is thought to be due to increased complement activation and a disruption of its regulatory mechanisms. We present a case of 27-year-old Primigravida of Asian ethnicity at 34 weeks gestation, who initially was diagnosed with HELLP syndrome based on jaundice, thrombocytopenia, elevated blood pressure, and abnormal liver function. However, subsequent investigations revealed a progressive decline in renal function, thrombocytopenia and low C3 complement levels raising suspicion for atypical hemolytic uremic syndrome (aHUS). This case highlights the diagnostic challenges and the importance of differentiating between HELLP syndrome and aHUS, particularly in the setting of complement abnormalities, as management strategies differ significantly.