Postpartum Hemolytic Uremic Syndrome Associated with Antiphospholipid Antibodies

Abstract

Postpartum hemolytic uremic syndrome (HUS) is described in a woman with a history of spontaneous abortions and both circulating lupus anticoagulant and anticardiolipin antibody (ACA). After termination of her pregnancy because of severe preeclampsia, ACA blood levels increased simultaneously with the onset of a microangiopathic process associated with severe hypertension and renal failure. Plasma exchange resulted in a rapid decline in ACA levels and immediate improvement in her clinical condition. This case strongly suggests an important causal relationship between ACA and postpartum HUS. The possible mechanisms of ACA-related postpartum HUS and the potential role of plasmapheresis in its treatment are reviewed and discussed.

Persistant pre-eclampsia post partum with elevated liver enzymes and hemolytic uremic syndrome

“…Anti-cardiolipin antibody (ACA) has been found in the group of mothers having spontaneous abortions associated with lupus anti-coagulant (LAC) and post partum HUS [63]. A case showed increased ACA levels after delivery because of severe pre-eclampsia with onset of microangiopathic renal failure [63].…”

“…A case showed increased ACA levels after delivery because of severe pre-eclampsia with onset of microangiopathic renal failure [63]. This was said to be distinct from the occlusive vasculopathy associated with anti-phospholipid antibodies [63].…”

Anticardiolipin Antibodies in Classic Pediatric Hemolytic-Uremic Syndrome: A Possible Pathogenic Role

“…Kincaid-Smith et al [10] in 1988 and later Kniaz et al [11] in 1992 were the first to suggest a potential association between antiphospholipid antibodies and the renal vascular thrombosis observed in the adult, obstetric form of HUS.…”

“…Their relationship with the presence of glomerular thrombosis has not been studied sufficiently, but a possible pathogenic role has been suggested at least in the adult form of the HUS [10, 11]. …”

Thrombotic microangiopathic haemolytic anaemia and antiphospholipid antibodies

“…The causes of death were catastrophic APS (three patients), infection (three patients), and myocardial infarction, massive cerebral haemorrhage, and massive haemorrhage after abdominal surgery (one case each). The remaining patient 37 illustrates the difficulty of establishing the differential diagnosis between TTP and catastrophic APS. This patient presented with a clinical picture of SLE with diffuse proliferative glomerulonephritis and thrombotic microangiopathy.…”