Differentiating between acute fatty liver of pregnancy (AFLP) and haemolysis, elevated liver enzyme and low platelet (HELLP) syndrome may be difficult. The treatment for both conditions is expedited delivery, with the infrequent exception of expectant management with close monitoring and consideration of dexamethasone with HELLP in the setting of severe prematurity. Correct diagnosis may have implications for maternal morbidity and mortality, risk of recurrence, risk to the child, and the risk of long-term maternal disease. The Swansea criteria lack specificity, a significant proportion of women with HELLP fulfilling criteria. Low antithrombin III, elevated circulating soluble Fms-like tyrosine kinase-1, hypocholesterolaemia, hypofibrinogenaemia, and reduced portal vein blood flow velocity have been proposed as differentiating AFLP from HELLP. A case of presumed AFLP associated with hypocholesterolaemia is presented, and the literature regarding markers in the differentiation of AFLP from HELLP is discussed. Hypocholesterolaemia may be useful in differentiating between AFLP and HELLP syndrome, particularly in resource-limited settings.
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