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‘It does not end with delivery?’ Pregnancy-associated thrombotic microangiopathy in the setting of postpartum preeclampsia/eclampsia – case report

Year: 2025

Type: article

Abstract: INTRODUCTION: Pregnancy-associated thrombotic microangiopathy (TMA) is potentially life-threatening disorder which refers to endothelial injury as the main culprit. Our case demonstrates true severity of pregnancy-associated TMA in postpartum period and diagnostic challenges in obtaining correct diagnosis. CASE PRESENTATION: pregnancy due to preeclampsia. Postpartum period was complicated with TMA and continuous need for antihypertensive therapy. Due to suspicion of thrombotic thrombocytopenic purpura (TTP), plasmapheresis was started. After dismissing TTP diagnosis, plasmapheresis was continued while perusing other possible pregnancy-associated TMAs. After a period of stabilisation, anaemia and thrombocytopenia worsened with signs of renal impairment and the patient experienced hypertensive crisis, culminating with grand mal epileptic seizure. She was sedated and treated with intravenous antihypertensive therapy in the Intensive care unit setting. Anti-complement therapy was obtained due to high suspicion of atypical haemolytic uraemic syndrome (aHUS) but ultimately was not delivered due to the rapid improvement in clinical and laboratory findings. No high-risk polymorphism for aHUS were detected, rather multiple common risk variants for complement mediated TMA. The patient experienced full clinical recovery with minimal residual renal impairment. CONCLUSION: this case is an example of pregnancy-associated TMA in the setting of preeclampsia in postpartum period which progressed to eclampsia due to the uncontrolled arterial hypertension. Upon vigorous blood pressure management, signs of TMA fully subsided.

Source: Blood Pressure

DOI: 10.1080/08037051.2025.2511212

Authors: I. Ivanko, Ž. Dika, I. Ćelap, V. Vukosav, P. Gaćina, J. Josipović

Institutions: University Hospital Centre Zagreb, Catholic University of Croatia, Sisters of Charity Hospital, University of Zagreb

Language: English

Topic: Complement system in diseases

Subfield: Immunology

Field: Immunology and Microbiology

Domain: Life Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,650