The conundrum of postpartum thrombotic Microangiopathy: case report and considerations for management

被引:4
作者
Artinger, Katharina [1 ]
Hackl, Gerald [2 ]
Schilcher, Gernot [2 ]
Eisner, Florian [2 ]
Pollheimer, Marion J. [3 ]
Mache, Christoph [4 ]
Weiss, Eva-Christine [5 ]
Eller, Kathrin [1 ]
Eller, Philipp [2 ]
机构
[1] Med Univ Graz, Clin Div Nephrol, Dept Internal Med, Graz, Austria
[2] Med Univ Graz, Intens Care Unit, Dept Internal Med, Auenbruggerpl 15, A-8036 Graz, Austria
[3] Med Univ Graz, Inst Pathol, Graz, Austria
[4] Med Univ Graz, Div Gen Pediat, Dept Pediat & Adolescent Med, Graz, Austria
[5] Med Univ Graz, Dept Obstet & Gynecol, Graz, Austria
基金
奥地利科学基金会;
关键词
Thrombotic microangiopathy; Preeclampsia; HELLP syndrome; Plasma exchange; Eculizumab;
D O I
10.1186/s12882-019-1286-1
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Microangiopathic hemolytic anemias and thrombocytopenias in pregnant or postpartum women constitute an interdisciplinary diagnostic and therapeutic challenge in the evaluation of thrombotic microangiopathies (TMA), where urgent care must be considered. We here report the case of a 21-year-old Somali woman, who was delivered by emergency caesarean section at 35 weeks of gestational age with acute dyspnea, placental abruption and gross edema due to severe preeclampsia/HELLP syndrome. After delivery, she developed acute kidney failure and thrombotic microangiopathy as revealed by kidney biopsy. The lack of early response to plasma exchange prompted extensive laboratory workup. Ultimately, the patient completely recovered with negative fluid balance and control of severe hypertension. This case report emphasizes the importance to differentiate between primary TMA syndromes and microangiopathic hemolytic anemias due to systemic disorders. Delayed recovery from preeclampsia/HELLP syndrome and malignant hypertension can clinically mimic primary TMA syndromes in the postpartum period.
引用
收藏
页数:4
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