Complement-mediated hemolytic uremic syndrome associated with postpartum hemorrhage: case series and systematic review of individual participant data
Background: Postpartum hemorrhage is considered a risk factor for pregnancy-associated complement-mediated hemolytic uremic syndrome (CM-HUS; previously known as atypical hemolytic uremic syndrome) but has not been systematically studied. Objectives: To systematically examine the role of postpartum...
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Elsevier
2024-11-01
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| Series: | Research and Practice in Thrombosis and Haemostasis |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2475037924002747 |
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| author | Anna Gurevich-Shapiro Sharon Orbach-Zinger Avi Leader Galia Stemer Arnon Wiznitzer Pierre Singer Miriam Davidovits Michael Shapiro Eva N. Hamulyák Pia Raanani Galia Spectre |
| author_facet | Anna Gurevich-Shapiro Sharon Orbach-Zinger Avi Leader Galia Stemer Arnon Wiznitzer Pierre Singer Miriam Davidovits Michael Shapiro Eva N. Hamulyák Pia Raanani Galia Spectre |
| author_sort | Anna Gurevich-Shapiro |
| collection | DOAJ |
| description | Background: Postpartum hemorrhage is considered a risk factor for pregnancy-associated complement-mediated hemolytic uremic syndrome (CM-HUS; previously known as atypical hemolytic uremic syndrome) but has not been systematically studied. Objectives: To systematically examine the role of postpartum hemorrhage in precipitating CM-HUS and to describe the characteristics of postpartum hemorrhage-associated CM-HUS, its prognosis and recommended management. Methods: A systematic review of individual participant data from case series and reports in addition to a case series from our institution. Search terms were “thrombotic microangiopathy,” “atypical hemolytic uremic syndrome,” and “complement mediated” combined with “pregnancy,” “postpartum,” and/or “postpartum hemorrhage”. Cases of thrombotic microangiopathy other than CM-HUS were excluded. Outcomes were clinical and laboratory characteristics of postpartum hemorrhage-associated CM-HUS, treatment, and outcomes. Results: Thirty-three studies comprising 48 women with postpartum hemorrhage-associated CM-HUS and 3 patients from our institution were included in the study. Most women presented at term (28/45; 62%), delivered by cesarean section (21/41; 51%), and had pregnancy complications, mainly preeclampsia (16/51; 31%) or fetal demise (9/51; 18%). Hematological and renal abnormalities usually appeared within the first 24 hours postdelivery. The median platelet count was 46 × 109/L (IQR, 26-72), and the median maximal lactate dehydrogenase was 2638 U/L (IQR, 1620-3588). Renal function normalized in 20/23 (87%) women treated with C5 inhibitors with or without plasma exchange; in 7/11 (63%) women treated with plasma exchange alone, but only in 3/17 (18%) patients treated with supportive care. Patients treated with C5 inhibitors and/or plasma exchange achieved significantly better renal outcomes compared with supportive care alone (P < .001). Conclusion: CM-HUS is a rare complication following postpartum hemorrhage and occurs mainly in women with preeclampsia and/or following cesarean section. Patients treated with C5 inhibitors and/or plasma exchange had a better renal prognosis compared with patients who received supportive treatment alone. |
| format | Article |
| id | doaj-art-6dfd371bbacb480d9edb000862f93a6e |
| institution | OA Journals |
| issn | 2475-0379 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Research and Practice in Thrombosis and Haemostasis |
| spelling | doaj-art-6dfd371bbacb480d9edb000862f93a6e2025-08-20T02:32:22ZengElsevierResearch and Practice in Thrombosis and Haemostasis2475-03792024-11-018810257910.1016/j.rpth.2024.102579Complement-mediated hemolytic uremic syndrome associated with postpartum hemorrhage: case series and systematic review of individual participant dataAnna Gurevich-Shapiro0Sharon Orbach-Zinger1Avi Leader2Galia Stemer3Arnon Wiznitzer4Pierre Singer5Miriam Davidovits6Michael Shapiro7Eva N. Hamulyák8Pia Raanani9Galia Spectre10Department of Systems Immunology, Weizmann Institute of Science, Rehovot, Israel; Division of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel; Correspondence Anna Gurevich-Shapiro, Ido Amit Lab for Immunogenomics, Weizmann Insitute of Science, Rehovot 7610001, Israel.Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel; Division of Anesthesia, Rabin Medical Center, Petah Tikva, IsraelFaculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel; Institute of Hematology, Rabin Medical Center, Petah Tikva, IsraelHematology Unit, Haemek Medical Center, Afula, IsraelFaculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel; Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, IsraelFaculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel; Intensive Care Unit, Rabin Medical Center, Petah Tikva, IsraelFaculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel; Institute of Nephrology, Schneider Children’s Medical Center, Rabin Medical Center, Petah Tikva, IsraelFaculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel; Department of Internal Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, IsraelDepartment of Internal Medicine, Amsterdam University Medical Center, Amsterdam, The NetherlandsFaculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel; Institute of Hematology, Rabin Medical Center, Petah Tikva, IsraelFaculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel; Institute of Hematology, Rabin Medical Center, Petah Tikva, IsraelBackground: Postpartum hemorrhage is considered a risk factor for pregnancy-associated complement-mediated hemolytic uremic syndrome (CM-HUS; previously known as atypical hemolytic uremic syndrome) but has not been systematically studied. Objectives: To systematically examine the role of postpartum hemorrhage in precipitating CM-HUS and to describe the characteristics of postpartum hemorrhage-associated CM-HUS, its prognosis and recommended management. Methods: A systematic review of individual participant data from case series and reports in addition to a case series from our institution. Search terms were “thrombotic microangiopathy,” “atypical hemolytic uremic syndrome,” and “complement mediated” combined with “pregnancy,” “postpartum,” and/or “postpartum hemorrhage”. Cases of thrombotic microangiopathy other than CM-HUS were excluded. Outcomes were clinical and laboratory characteristics of postpartum hemorrhage-associated CM-HUS, treatment, and outcomes. Results: Thirty-three studies comprising 48 women with postpartum hemorrhage-associated CM-HUS and 3 patients from our institution were included in the study. Most women presented at term (28/45; 62%), delivered by cesarean section (21/41; 51%), and had pregnancy complications, mainly preeclampsia (16/51; 31%) or fetal demise (9/51; 18%). Hematological and renal abnormalities usually appeared within the first 24 hours postdelivery. The median platelet count was 46 × 109/L (IQR, 26-72), and the median maximal lactate dehydrogenase was 2638 U/L (IQR, 1620-3588). Renal function normalized in 20/23 (87%) women treated with C5 inhibitors with or without plasma exchange; in 7/11 (63%) women treated with plasma exchange alone, but only in 3/17 (18%) patients treated with supportive care. Patients treated with C5 inhibitors and/or plasma exchange achieved significantly better renal outcomes compared with supportive care alone (P < .001). Conclusion: CM-HUS is a rare complication following postpartum hemorrhage and occurs mainly in women with preeclampsia and/or following cesarean section. Patients treated with C5 inhibitors and/or plasma exchange had a better renal prognosis compared with patients who received supportive treatment alone.http://www.sciencedirect.com/science/article/pii/S2475037924002747postpartum hemorrhagepregnancyComplement C5 inhibitorsatypical hemolytic uremic syndromethrombotic microangiopathiespregnancy complications |
| spellingShingle | Anna Gurevich-Shapiro Sharon Orbach-Zinger Avi Leader Galia Stemer Arnon Wiznitzer Pierre Singer Miriam Davidovits Michael Shapiro Eva N. Hamulyák Pia Raanani Galia Spectre Complement-mediated hemolytic uremic syndrome associated with postpartum hemorrhage: case series and systematic review of individual participant data Research and Practice in Thrombosis and Haemostasis postpartum hemorrhage pregnancy Complement C5 inhibitors atypical hemolytic uremic syndrome thrombotic microangiopathies pregnancy complications |
| title | Complement-mediated hemolytic uremic syndrome associated with postpartum hemorrhage: case series and systematic review of individual participant data |
| title_full | Complement-mediated hemolytic uremic syndrome associated with postpartum hemorrhage: case series and systematic review of individual participant data |
| title_fullStr | Complement-mediated hemolytic uremic syndrome associated with postpartum hemorrhage: case series and systematic review of individual participant data |
| title_full_unstemmed | Complement-mediated hemolytic uremic syndrome associated with postpartum hemorrhage: case series and systematic review of individual participant data |
| title_short | Complement-mediated hemolytic uremic syndrome associated with postpartum hemorrhage: case series and systematic review of individual participant data |
| title_sort | complement mediated hemolytic uremic syndrome associated with postpartum hemorrhage case series and systematic review of individual participant data |
| topic | postpartum hemorrhage pregnancy Complement C5 inhibitors atypical hemolytic uremic syndrome thrombotic microangiopathies pregnancy complications |
| url | http://www.sciencedirect.com/science/article/pii/S2475037924002747 |
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