Therapeutic plasma exchange for early aggressive management of post-partum hemolytic uremic syndrome: a tertiary care centre experience

摘要

Postpartum hemolytic uremic syndrome is an unusual condition of obscure origin that manifests with hemolytic anemia, thrombocytopenia and acute renal failure after delivery. We describe a case of 28 year old woman referred to our hospital in view of severe renal failure, 24 hours after the delivery by caesarean section for scar rupture and placental abruption. She was in a delirious state and had anuria, severe anemia and moderate thrombocytopenia. After many diagnostic dilemmas, a final diagnosis of hemolytic uremic syndrome was made. Aggressive treatment with plasma exchange in conjunction with hemodialysis was started. Fresh frozen plasma was used for replacement and four consecutive plasmapheresis sessions were instituted. Simultaneously steroids and anti-hypertensive drugs were given. Two weeks later, quick clinical and laboratory response was noted. There was significant improvement in renal functions along with resolution of signs of active hemolysis. This case collaborates with the ideal scenario involving prompt diagnosis and early aggressive treatment with plasma exchange in a postpartum hemolytic uremic syndrome patient.