Therapeutic Plasma Exchange in Postpartum Hemolytic Uremic Syndrome: A Case Report

Therapeutic Plasma Exchange in Postpartum Hemolytic Uremic Syndrome: A Case Report


Department of ImmunoHematology and Blood Transfusion Dayanand Medical College and Hospital

BACKGROUND AND AIM: Adult, non-infective, haemolytic-uremic syndrome (HUS) although a rare disease in itself, has a high likelihood of occurrence in pregnancy and immediate post partum period. It is an important differential diagnosis in the evaluation of thrombotic microangiopathies. Patients with post-partum HUS display a classical triad of microangiopathic haemolytic anaemia, acute nephropathy and thrombocytopenia.

I hereby present a case of post partum HUS treated with therapeutic plasma exchange (TPE)

MATERIAL AND METHODS: A total of six sessions of TPE were performed daily, three sessions for consecutive days and remaining three sessions were performed on alternate days. All the procedures were carried out with Haemonetics MCS+ exchanging one plasma volume using fresh frozen plasma and saline as replacement fluid. Haemodialysis was started and four sessions were carried out on alternate days.

RESULT: A 37 year old, 85 kg female, G2 P1, underwent emergency LSCS because of foetal distress at 38 weeks of pregnancy. Post surgery she developed decreasing urine output, anuria ensued. Emergency therapeutic plasma exchange was carried out within 24 hours of diagnosis. It could be found that with TPE, patient had improvement in renal function, decrease in LDH levels and increase in platelet count. Patient had sustained remission and discontinuation of haemodialysis.

CONCLUSION: HUS is a disorder with high mortality and long term morbidity, if prompt treatment is not instituted. The decision to intervene with plasma exchange should be based upon the severity of thrombocytopenia, microangiopathic haemolytic anaemia and neurological abnormalities, even if the diagnosis and nomenclature is uncertain. Improved survival after this disorder has been attributed to aggressive treatment with plasma exchange therapy.

Keywords: Therapeutic Plasma Exchange; Postpartum Hemolytic Uremic Syndrome; Case Report

Free Full-text PDF

How to cite this article:

SIRAT KAUR. Therapeutic Plasma Exchange in Postpartum Hemolytic Uremic Syndrome: A Case Report. International Journal of Case Reports, 2021,5:229. DOI: 10.28933/ijcr-2021-07-0309


1. Weiner CP. Thrombotic microangiopathy in pregnancy and the postpartum period. Semin hematol 1987:24:119-29
2. Dashe JS, Ramin SM, Cunningham FG. The long term subsequence of thrombotic microangioapathy in pregnancy. Obstet Gynecol 1998;91;662-8
3. Edward Zimbudzi . Overcoming technical challenges when treating atypical hemolytic uremic syndrome with therapeutic plasma exchange. Int J Nephrol Renovasc Dis. 2013; 6: 245–248.
4. McMinn JR, George JN. Evaluation of women with clinically suspected thrombotic thrombocytopenic purpura – hemolytic uremic syndrome during pregnancy. JClin Apheresis. 2001;16:202–96.
5. Egerman RS, Witlin AG, Friedman SA, Sibai BM. Thrombotic thrombocytopenic purpura and hemolytic uremic syndrome in pregnancy: review of 11 cases. Am J Obstet Gynecol. 1996;175:950.
6. Bell WR, Braine HG, Ness PM, Kickler TS. Improvement in survival in thrombotic thrombocytopenic purpura-hemolytic uremic syndrome. Clinical experience in 108 atients. N Engl J Med 1991;325:398–403.
7. Schwartz J,Winters JL,Padmanabhan A et al: Guidelines on the Use of Therapeutic Apheresis in Clinical Practice. Journal of Clinical Apheresis 2013 28:145–284
8. Kwaan, Hau C. Soff, Gerald A. Management of thrombotic thrombocytopenic purpura and hemolytic uremic syndrome. Sem Hematol 1997; 34:159-166

Terms of Use/Privacy Policy/ Disclaimer/ Other Policies:
You agree that by using our site, you have read, understood, and agreed to be bound by all of our terms of use/privacy policy/ disclaimer/ other policies (click here for details)

CC BY 4.0
This work and its PDF file(s) are licensed under a Creative Commons Attribution 4.0 International License.