No HELLP at all: Post-partum atypical hemolytic uremic syndrome treated with Eculizumab: A case report

Abstract

Atypical hemolytic uremic syndrome (aHUS) is a rare condition among thrombotic microangiopathies (TMA). Pregnancy is a known precipitating factor of complement mediated TMA. The occurrence of microangiopathic hemolytic anemia, thrombocytopenia and acute kidney injury presents diagnostic and therapeutic challenges. Diverse causes include hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome) in pregnant women. In pregnancy or postpartum, the occurrence of aHUS is a critical complication requiring urgent diagnosis and treatment. aHUS is considered to be the result of the underlying condition, with the understanding that therapy is focused on the underlying condition. Five documented cases of pregnancy-associated aHUS treated with Eculizumab have been reported, making the condition extremely rare. We present the case of a pregnant woman with HELLP syndrome induced aHUS. The patient presented with evidence of dysregulation of the complement system and renal insufficiency. Since the initiation of Eculizumab, a C5 complement inhibitor, the development of renal insufficiency diminished and the patient became dialysis independent.