HELLP syndrome is characterized by liver compromise during or after a pregnancy, complicated by hypertension and/or preeclampsia. The letters stand for: H emolytic anemia (when red blood cells break down) E levated L iver transminases (sign of liver problems) L ow P latelet count (causing problems in blood clotting). This condition usually appears in the third trimester and most commonly in first-time pregnancies, but it can begin as early as 20 weeks and recur in subsequent pregnancies. A simple explanation of the disease is that it is a very severe form of preeclampsia. About 15 percent (in one study) of women with preeclampsia go on to develop HELLP.