Therapeutic plasma exchange for early aggressive management of post-partum hemolytic uremic syndrome: a tertiary care centre experience

Authors

  • Vineet Mishra Department of Obstetrics and Gynaecology, IKDRC, Ahmedabad, Gujarat, India
  • Himani Agarwal Department of Obstetrics and Gynaecology, IKDRC, Ahmedabad, Gujarat, India
  • Sugandha Goel Department of Obstetrics and Gynaecology, IKDRC, Ahmedabad, Gujarat, India
  • Sumesh Choudhary Department of Obstetrics and Gynaecology, IKDRC, Ahmedabad, Gujarat, India
  • Rohina Aggarwal Department of Obstetrics and Gynaecology, IKDRC, Ahmedabad, Gujarat, India
  • Priyankur Roy Department of Obstetrics and Gynaecology, IKDRC, Ahmedabad, Gujarat, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20164680

Keywords:

Hemodialysis, Plasmapheresis, Postpartum hemolytic uremic syndrome

Abstract

Postpartum hemolytic uremic syndrome is an unusual condition of obscure origin that manifests with hemolytic anemia, thrombocytopenia and acute renal failure after delivery. We describe a case of 28 year old woman referred to our hospital in view of severe renal failure, 24 hours after the delivery by caesarean section for scar rupture and placental abruption. She was in a delirious state and had anuria, severe anemia and moderate thrombocytopenia. After many diagnostic dilemmas, a final diagnosis of hemolytic uremic syndrome was made. Aggressive treatment with plasma exchange in conjunction with hemodialysis was started. Fresh frozen plasma was used for replacement and four consecutive plasmapheresis sessions were instituted. Simultaneously steroids and anti-hypertensive drugs were given. Two weeks later, quick clinical and laboratory response was noted. There was significant improvement in renal functions along with resolution of signs of active hemolysis. This case collaborates with the ideal scenario involving prompt diagnosis and early aggressive treatment with plasma exchange in a postpartum hemolytic uremic syndrome patient.

References

Hayslett JP. Postpartum renal failure. N Engl J Med. 1985;312:1556-9.

Robson JS, Martin AM, Ruckley VA, MacDonald MK. Irreversible postpartum renal failure. A new syndrome. Q J Med. 1968;37:423-35.

Santos Nores J, Bravo Lopez JJ, Borajjo Prol MP, Iglesias Forneiro A. HTA-pre-eclampsia-postpartum hemolytic-uremic syndrome: good results can be achieved. Nefrologia. 2010;30:593-4.

Wagoner RD, Holley DE, Johnson WJ. Accelerated nephrosclerosis and postpartum acute renal failure in normotensive patients. Ann Intern Med. 1968;69:237.

Clarcson AR, Meadows R, Lawrence JR. Postpartum renal failure? The generalized Shwartzman reaction. Australas Ann Med. 1969;18:209.

Rosenmann E, Kanter A, Bacani RA, Pirani CL, Pollak VE. Fatal late postpartum intravascular coagulation with acute renal failure. Am J Med Sci. 1969:257-9.

Yingdong HE, Jicheng LV, Chen Q. Postpartum hemolytic uremic syndrome: report of three cases and literature review. Chin J Perinat Med. 2010;13:114-6.

Churg J, Goldstein MH, Bernstein J. Thrombotic microangiopathy including hemolytic uremic syndrome, thrombotic thrombocytopenic purpura and postpartum renal failure. In: Renal pathology with clinical and functional correlations by Tisher CC, Brener BM. 1989;1091.

Segonds A, Louradour N, Suc JM, Orfila C. Postpartum hemolytic uremic syndrome: a study of three cases with a review of the literature. Clin Nephrol. 1979;12(5):229-42.

Morel-Maroger L, Kanfer A, Solez K, Sraer JD, Richel G. Prognostic importance of vascular lesions in acute renal failure with microangiopathic hemolytic anemia (hemolytic-uremic syndrome): clinico pathologic study in 20 adults. Kidney Int. 1979;15:548-58.

Michael H, Hymphreys, Allen C Alfrey. Vascular disease of the kidney. In: Brenner BM, Rector FC. The kidney. 3rd ed. 1986; 1185.

Remuzzi G, Bertani T. Thrombotic thrombocytopenic purpura, hemolytic uremic syndrome, and acute cortical necrosis. In: Schrier RW, Gottschalk CW, eds. Diseases of the kidney. 4th ed. 1988; 2301.

Misiani R, Appiani AC, Edefonti A. Haemolytic-uraemic syndrome: therapeutic effect of plasma infusion. Br Med J. 1982;285:1304-6.

De Jong M, Monnens L. Haemolytic-uraemic syndrome: a 10-year follow-up study of 73 patients. Nephrol Dial Transplant. 1988;3:379-82.

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Published

2016-12-20

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Case Reports