1. IntroductionThe HELLP syndrome is characterized by elevated liver enzymes, hemolysis, and thrombocytopenia. It has a low incidence during pregnancy but a poor prognosis. Once it occurs, it often has an acute onset, develops rapidly, and seriously threatens the safety of both the mother and the fetus [1]. The combination of HELLP syndrome with rupture of subcapsular hepatic hematoma and TMA is extremely rare, and the severity of the condition escalates exponentially. Through in - depth analysis of this highly challenging case successfully diagnosed and treated in the Affiliated Hospital of Jining Medical University, this study systematically summarizes its pathogenesis, clinical characteristics, and treatment experience, aiming to provide valuable reference for clinicians and improve the understanding, diagnosis, and treatment of such diseases.