Haemolytic‐uraemic syndrome during the first trimester of pregnancy

Abstract

The association of pregnancy with acute renal failure, microangiopathic haemolytic anaemia and thrornbocytopenia is an unusual but well described event occurring typically in the postpartum period (Robson et al. 1968;Schoolwerth et al. 1976) and this may be recurrent (Gomperts et al. 1978). One patient has been described in the fifth month of pregnancy, in whom no improvement in renal function was observed after heparin therapy, and persistent malignant hypertension required bilateral nephrectomy (Vandewall et al. 1975). We record a similar case history occurring in the first trimester. Case reportA 25-year-old white primigravida was seen during the first trimester of pregnancy complaining of easy bruising, particularly on her legs. In the previous year menorrhagia had been managed on a mini-oestrogen contraceptive for 2 months. Six months before presentation she had married and was at that time asymptomatic. She had taken no medication in the 3 months before her presentation. having been fitted with an intrauterine contraceptive device instead. Her past history was not contributary; physical examination was normal.On examination the patient was pale with some bruises and scattered purpuric spots present over the lower extremities. Blood pressure was 120/70 mmHg and all pulses were present and equal. Initial haemoglobin was 9 . 2 g/dl, with normal erythrocyte indices but marked fragmentation present on the peripheral blood smear. Uncorrected reticulocyte count was 0306-5456/83/0600-0578%02.00 C 1983 British Journal of Obstetrics and Gynaecologj, 5 78 12.7% and ESR was 1 6 m m in 1 h. Total leucocyte count was 7.2x1OY/1 with a normal differential count and platelets 48x 10y/l. Bonemarrow examination showed a hypercellular marrow with normoblastic hyperplasia, normal granulopoiesis and megakaryocyte numbers. There was no iron demonstrable in marrow reticuloendothelial cells.Urine examination showed 2 + proteinuria with microscopic haernaturia. No casts or other abnormalities were present.Blood urea was 56 (normal 20-35) mg/ml, creatinine 1.6 (normal 0.5-0.8) mg/ml and creatinine clearance 73 (normal 86-1 10) ml/min. Lactic dehydrogenase and unconjugated bilirubin levels were raised, but the remainder of the biochemical profile was normal.Chest X-ray and electrocardiogram were normal. Haemoglobin electrophoresis, Coombs' test, serology for collagen-vascular disease, VDRL, Paul Bunnell and antiplatelet antibodies were all negative. Bleeding time was 15 (normal 2-8) min and platelet sizing showed increased megathrombocytes.Fibrinogen, fibrinogen degradation products, prothrombin time, reptilase time, partial thromboplastin time and thrombin time were normal. Screening tests for lymphocytotoxic antibodies were negative.In the the course of the next week the patient remained well, but falling haemoglobin and persisting erythrocyte fragmentation were cause for concern. With informed consent, the pregnancy was terminated by vacuum extraction followed by curettage. Despite this procedure there was a further fall in haemo...

Hemorrhagic Colitis with <i>Streptococcus pyogenes </i>Preceding Hemolytic Uremic Syndrome during Early Pregnancy

“…Many cases have already been described in adults in various circumstances, including the end of pregnancy or the postpartum period. However, the HUS has only been reported in I case during the first trimester of pregnancy [1]. We report here another case, in which the involvement of a streptococcal infection is probable.…”

Pregnancy outcomes after recovery from thrombotic thrombocytopenic purpura–hemolytic uremic syndrome

“…Of 328 articles retrieved for review, 44 articles published from 1968 to 2002 described 49 women with 70 pregnancies after recovery from TTP‐HUS. Twenty‐one of the women were described in single‐patient case reports; 9‐32 18 women were described in case series of 2 to 16 patients; 33‐47 10 women were superficially described in four case series of 44 to 108 patients 48‐52 . Risk factors for pregnancy complications were not described in 45 of the 49 women.…”

Postpartum haemolytic uraemic syndrome precipitated by antibiotics. Case report

“…The association of the condition with pregnancy is an unusual, but well-described, event occurring typically in the postpartum period within a few days to approximately 10 weeks after an apparently normal pregnancy and delivery (Robson r t al., 1968;Wagoner et al, 1968;Hayslett 1985). The condition has also been described in the first and second trimesters of pregnancy (Vandewalle et al, 1975;Jacobs 1983). in association with ectopic prcgnancy (Crcasy &Morgan 1987), and in patients on the oral contraceptive pill (Schoolwerth et ol., 1976;Hoorntje et ul., 1981: Brown el Stenger er al., 1988).…”