SHM Converge Scientific Abstract ePoster Gallery-Complement Mediated Hemolytic Uremic Syndrome: A Rare Life-Threatening Postpartum Complication

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This case describes a 23-year-old woman who developed vomiting and jaundice 6 days after delivery complicated by preeclampsia. She presented with severe thrombocytopenia, hemolytic anemia, elevated creatinine, and abnormal liver tests, raising concern for thrombotic microangiopathy. Because her PLASMIC score was 7, thrombotic thrombocytopenic purpura (TTP) was initially suspected, and plasma exchange plus steroids were started.<br /><br />However, her platelet count remained low and kidney function worsened despite treatment. ADAMTS13 activity returned normal at 78%, effectively excluding TTP. Complement levels were normal and autoimmune testing was negative, so steroids were stopped. Given the postpartum setting and ongoing concern for complement-mediated hemolytic uremic syndrome (aHUS), eculizumab was planned.<br /><br />HELLP syndrome was considered less likely because the presentation occurred late postpartum. Since no single definitive test exists for aHUS, the authors emphasize that treatment with anti-complement therapy should begin based on clinical suspicion rather than waiting for confirmation. Plasma exchange and anti-complement therapy can be given together when the diagnosis is uncertain.<br /><br />A kidney biopsy was planned but led to a retroperitoneal bleed and cardiac arrest, though return of spontaneous circulation was achieved and emergent embolization was performed. The patient continued weekly eculizumab, gradually improved, and was discharged on day 20 with normal creatinine.<br /><br />The report highlights that pregnancy and postpartum states increase the risk of aHUS due to enhanced complement activation. Because aHUS can mimic TTP and HELLP syndrome, early recognition is critical. Delaying anti-complement therapy may result in irreversible renal failure, dialysis dependence, or death.

Asset Subtitle

Prekchha Jha

Meta Tag

Author List Dilip Khanal, Pawan Gyawali, Prekchha Jha

Category Clinical Vignettes

Concept Postpartum Thrombotic Microangiopathy

Concept Atypical Hemolytic Uremic Syndrome

Concept Thrombotic Microangiopathy

Concept Thrombotic Thrombocytopenic Purpura

Concept Eculizumab

Distinguished Non-Finalist

Presenter Organization Corewell Health William Beaumont University Hospital, Royal Oak, MI

Presenting Author Prekchha Jha

Track Adult

Keywords

postpartum aHUS

thrombotic microangiopathy

thrombotic thrombocytopenic purpura

HELLP syndrome

ADAMTS13

eculizumab

preeclampsia

hemolytic anemia

acute kidney injury

complement-mediated hemolytic uremic syndrome

Postpartum Thrombotic Microangiopathy

Atypical Hemolytic Uremic Syndrome

Thrombotic Microangiopathy

Thrombotic Thrombocytopenic Purpura

Eculizumab