Pregnancy-induced atypical haemolytic uremic syndrome: A new era with eculizumab. (March 2018)

• Record Type: Journal Article
• Authors: Shanmugalingam, Renuka; Hsu, Danny; Makris, Angela
• Is Part Of: Obstetric medicine. Volume 11:Number 1(2018:Mar.)
• Page Start: 28
• Page End: 31
• Publication Date: 2018-03
• Subjects: Atypical haemolytic uremic syndrome -- haemolysis -- elevated liver enzymes -- low platelet syndrome -- eculizumab -- preeclampsia -- renal failure; Pregnancy -- Complications -- Periodicals; Obstetrics -- Periodicals; 618.2
• DOI: 10.1177/1753495X17704563
• Languages: English
• ISSNs: 1753-495X

Abstract

Pregnancy is a well-recognised trigger of atypical haemolytic syndrome (P-aHUS) and often occurs in the post-partum period. Similar to atypical haemolytic uremic syndrome, it carries a poor prognosis with high morbidity particularly in the form of renal failure. Early recognition and intervention is crucial in its management particularly with the recent availability of eculizumab, a humanized monoclonal antibody to complement component C5, which has demonstrated drastic improvement in prognosis. The issue, however, is arriving at a timely diagnosis given the considerable amount of overlap in the clinical and biochemical manifestation of P-aHUS, HELLP syndrome (haemolysis, elevated liver enzyme and low platelet count) and other hypertensive disorders of pregnancy. We present a case report and literature review that highlights the clinical conundrum of arriving at the diagnosis. We also highlight the importance of early management of P-aHUS with eculizumab and its impact on improving morbidity.