Thrombotic microangiopathy in the maternity ward from the anaesthesiologist‘s perspective –⁠ a case study

Overview

Thrombotic microangiopathies (TMAs) represent a major diagnostic and therapeutic challenge in obstetrics; any delay increases maternal mortality and morbidity. We describe the case of a 29-year-old multiparous woman (second delivery) in whom an eclamptic seizure necessitated an emergency caesarean section. Persistent severe hypertension, together with acute renal failure, microangiopathic non-immune haemolytic anaemia, and thrombocytopenia, led to the rapid diagnosis of complement-mediated TMA (cmTMA/atypical haemolytic uraemic syndrome). Prompt initiation of complement inhibition therapy (eculizumab) in combination with temporary intermittent haemodialysis resulted in recovery of renal function. This case highlights the importance of early differential diagnosis of TMA in pregnancy and the benefit of targeted complement-inhibitory therapy.

Keywords:

plasmapheresis – Eclampsia – Thrombocytopenia – caesarean section – atypical haemolytic uremic syndrome – microangiopathic haemolytic anaemia – HELLP