1. A pregnant woman at 32 weeks of gestation presents with severe epigastric

pain, nausea, and vomiting. Her blood pressure is 170/110 mmHg, and her urine

dipstick shows 3+ proteinuria. Her blood tests reveal hemoglobin of 9 g/dL,

platelet count of 60 x 10^9/L, AST of 120 U/L, ALT of 150 U/L, LDH of 800 U/L,

and serum creatinine of 1.5 mg/dL. Her peripheral blood smear shows

schistocytes. What is the most likely diagnosis?

A) Acute fatty liver of pregnancy

B) HELLP syndrome

C) Thrombotic thrombocytopenic purpura

D) Disseminated intravascular coagulation

**B) HELLP syndrome**

Rationale: HELLP syndrome is a severe form of preeclampsia characterized by

hemolysis, elevated liver enzymes, and low platelets. It typically occurs in the

third trimester and presents with hypertension, proteinuria, and symptoms such

as epigastric pain, nausea, vomiting, and headache. The diagnosis is based on

laboratory findings of hemolytic anemia, elevated liver enzymes, and

thrombocytopenia. The peripheral blood smear may show schistocytes due to

microangiopathic hemolysis. Acute fatty liver of pregnancy is a rare condition that

usually occurs in the third trimester and presents with nausea, vomiting,