Based on their much clinical experience, the authors present the specific features inherent in the development and therapy of HELLP syndrome characterized by a triad of symptoms (hemolysis, elevated hepatic aminotransferase levels, and thrombocytopenia). HELLP syndrome is always secondary, develops in severe preeclampsia; may develop in atypical preeclampsia and appears as one or two signs; may be a cause of enhanced toxemia due to childbirth-related stress and massive release of endogenous toxic substances into the bloodstream; develops in the presence of extragenital diseases and multiple organ dysfunction. The effective treatment for HELLP syndrome is extracorporeal detoxification and plasma exchange with donor-derived fresh frozen plasma. The paper describes 2 clinical cases of patients with HELLP syndrome, which suggest that efferent therapy in pregnant women at risk for HELLP syndrome ameliorates the manifestations of endogenous intoxication syndrome and prevents deterioration in the course of the disease. When the microsymptoms of HELLP syndrome appear, selective efferent therapy can stop the progression of the disease; the early use of apheresis technologies, where possible, is the method of choice when HELLP syndrome develops. The authors declare no conflicts of interest.