Hemolysis, Elevated Liver Enzymes, Low Platelets Syndrome Superimposed on Hemolytic Uremic Syndrome

Abstract

A pregnancy complicated by typical hemolytic uremic syndrome (HUS) and hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome is reported. At 20 weeks of gestation, a case of HUS was diagnosed, with Shiga toxin-producing Escherichia coli identified. Plasmapheresis allowed continuation of the pregnancy for 5 weeks. Superimposed preeclampsia and HELLP syndrome were diagnosed after the establishment of nephrotic range proteinuria, hypertension and recurrence of hemolysis. This is a singular case, as it demonstrates that HELLP syndrome can superimpose upon HUS, a fact that can impact future research on reproductive immunology. It also reminds clinicians that the overlapping of clinical and laboratory findings in HELLP syndrome makes the diagnosis of other thrombotic microangiopathies during pregnancy a clinical challenge. Palavras-chave► síndrome HELLP ► síndrome hemolítica-urêmica ► microangiopatias trombóticas ResumoDescreve-se um caso clínico em que às 20 semanas de gestação é diagnosticada síndrome hemolítica-urêmica com isolamento de Escherichia coli produtora de toxina Shiga. A terapêutica com plasmaferese permitiu a manutenção da gravidez ao longo de 5 semanas. O surgimento de proteinúria nefrótica, hipertensão e recorrência de hemólise conduziu ao diagnóstico de sobreposição de pré-eclâmpsia e síndrome HELLP. Este caso é singular, pois demonstra que a síndrome HELLP pode se sobrepor a uma síndrome hemolítica-urêmica, um fato que pode influenciar futuras investigações no âmbito de imunologia reprodutiva. Reforça-se, ainda, que o diagnóstico de outras microangiopatias trombóticas durante a gestação é um desafio clínico ocasionado pela sobreposição de manifestações clínicas e laboratoriais com a síndrome HELLP.

Fisiopatogenia e métodos diagnósticos das anemias hemolíticas: uma revisão integrativa.

“…Ainda dentro do grupo das anemias hemolíticas microangiopáticas, encontramos a síndrome HELLP, sendo H: hemólise (fragmentação das células do sangue); EL: elevação das enzimas hepáticas; e LP: baixa contagem de plaquetas. É uma complicação obstétrica grave, que pode ser facilmente confundida com a pré-eclâmpsia 78 .…”

Perspectives of Plasmapheresis in the Treatment of Kidney Diseases

“…Thus system and kidney microvessels with development as anuries, and encephalopathies with damage and other vital organs. [35] The role and of a complement C5 activation is possible and the technique of release of a complement inhibitormonoclonal antibodies anti-C5 is now developed, though efficiency and intensive courses of a plasma exchange is shown [36,37,38,39]. The case of a thrombotic microangiopathy with the phenomena of an acute renal failure against an antiphospholipid syndrome with a favorable outcome after a plasma exchange with immunosupression is described also [40].…”

Do Case Reports and Case Series Generate Clinical Discoveries About Preeclampsia? A Systematic Review

“…We present a further breakdown of each classification in Table 3. Of the included studies with a clinical discovery aspect, the following interventions were considered notable ones in the assessment of the reviewers: sildenafil administration in a patient with periviable pregnancy and preeclampsia; 70 selective fetal reduction in cases of discordance in dichorionic twin gestations in patients with preeclampsia or HELLP syndrome; 87,92 continuous positive airway pressure in patients with obesity, obstructive sleep apnea, preeclampsia, and a high risk of developing severe preeclampsia; 107,159 acupuncture therapy in a patient with preeclampsia; 109 plasma exchange therapy for patients with HELLP syndrome; 121,132 eculizumab in a patient with HELLP syndrome; 117 eplerenone in a patient with obesity, obstructive sleep apnea, and preeclampsia; 129 pravastatin in a patient with HELLP syndrome; 137 and dydrogesterone to prevent preeclampsia in a patient with a history of recurrent preeclampsia. 150 Authors of the included articles have clearly stated an observation-based scientific hypothesis in nine articles (8%), and we determined that there was an implied scientific hypothesis in 22 articles (21%).…”