Hemolysis, Elevated Liver Enzymes, Low Platelets Syndrome Superimposed on Hemolytic Uremic Syndrome.
A pregnancy complicated by typical hemolytic uremic syndrome (HUS) and hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome is reported. At 20 weeks of gestation, a case of HUS was diagnosed, with Shiga toxin-producing Escherichia coli identified. Plasmapheresis allowed continuation of the pregnancy for 5 weeks. Superimposed preeclampsia and HELLP syndrome were diagnosed after the establishment of nephrotic range proteinuria, hypertension and recurrence of hemolysis. This is a singular case, as it demonstrates that HELLP syndrome can superimpose upon HUS, a fact that can impact future research on reproductive immunology. It also reminds clinicians that the overlapping of clinical and laboratory findings in HELLP syndrome makes the diagnosis of other thrombotic microangiopathies during pregnancy a clinical challenge.
Department of Obstetrics, Gynecology and Reproductive Medicine, Centro Hospitalar Lisboa Norte, Hospital Santa Maria (CHLN-HSM), Lisbon, Portugal.
Inês
I
Martins
Department of Obstetrics and Gynecology, Hospital CUF Descobertas, Lisbon, Portugal.
Madalena Gomes
MG
Conceição
Intensive Care Unit, Hospital CUF Descobertas, Lisbon, Portugal.
Paulo Pereira
PP
Gomes
Department of Obstetrics, Gynecology and Reproductive Medicine, Centro Hospitalar Lisboa Norte, Hospital Santa Maria (CHLN-HSM), Lisbon, Portugal.
Nuno
N
Clode
D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D017359:HELLP Syndrome / Q000175:diagnosis*; D006463:Hemolytic-Uremic Syndrome / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D011247:Pregnancy