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Related Experiment Videos

Postpartum TMA requiring dialysis with discordant complement tests: a case report.

Hikari Fujimura1, Shun Minatoguchi2, Riku Takeuchi1

  • 1Department of Nephrology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-Cho, Toyoake, Aichi, 470-1192, Japan.

CEN Case Reports
|June 29, 2026
PubMed
Summary

Pregnancy can cause thrombotic microangiopathy (TMA), mimicking HELLP or complement-mediated TMA. This case highlights the importance of a trend-first approach and potential ex vivo complement activation in diagnosis.

Keywords:
AKICM-TMAHELLPPregnancyTMA

Related Experiment Videos

Area of Science:

  • Nephrology
  • Hematology
  • Obstetrics

Background:

  • Pregnancy-associated thrombotic microangiopathy (TMA) encompasses conditions like preeclampsia/HELLP and complement-mediated TMA (CM-TMA).
  • Distinguishing between these TMA subtypes is challenging due to overlapping clinical and laboratory features.
  • Accurate diagnosis is crucial as management and prognosis differ significantly.

Purpose of the Study:

  • To present a case of peripartum TMA that posed diagnostic challenges.
  • To illustrate the potential pitfalls in interpreting complement assays in the peripartum setting.
  • To advocate for a clinical trajectory-guided management approach for peripartum TMA.

Main Methods:

  • Case report of a 39-year-old woman with severe hypertension and subsequent anuria at 35 weeks gestation.
  • Clinical evaluation included assessment for hemolysis, thrombocytopenia, elevated LDH, and renal function.
  • Complement assays (CH50, C3, C4) were performed, with subsequent re-evaluation using EDTA plasma.

Main Results:

  • The patient presented with features suggestive of TMA, including schistocytic hemolysis, thrombocytopenia, and elevated LDH.
  • Initial complement tests showed atypical results (undetectable CH50, elevated C3/C4), complicating HELLP vs. CM-TMA differentiation.
  • Subsequent testing with EDTA plasma revealed a normal CH50, suggesting ex vivo complement activation.
  • Management focused on supportive care and brief plasma exchange, with subsequent recovery of urine output.

Conclusions:

  • A "trend-first" approach, focusing on clinical improvement, is valuable for managing peripartum TMA when diagnosis is uncertain.
  • Ex vivo complement activation is a critical consideration that can confound interpretation of complement assays in peripartum TMA.
  • Careful assay interpretation and clinical correlation are essential for optimal outcomes in pregnancy-related TMA.