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In Reply: Drs Minakami and Sato
point out that thrombocytopenia may be an early manifestation of
impending HELLP syndrome and suggest that my wife's platelet count may
have declined gradually to the level that led to the diagnosis only
when she was critically ill. Their comment makes an important point:
HELLP syndrome does not occur overnight. Rather, subtle symptoms and
signs of this disorder may be present for days (or even weeks, in some
cases) before the onset of crisis and may be detected with careful
Stone JH. HELLP Syndrome—Reply. JAMA. 1999;281(8):703–705. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-8-jbk0224
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