Early Identification and Eculizumab Treatment of Pregnancy-Associated Atypical Hemolytic Uremic Syndrome: A Case Report

Pregnancy-associated atypical hemolytic-uremic syndrome (p-aHUS) is a rare thrombotic microangiopathy that leads to increased fetal and maternal morbidity and mortality. Early identification and timely treatment can save lives and improve prognosis. p-aHUS should be highly suspected in patients presenting with microangiopathic hemolytic anemia, thrombocytopenia, and acute progressive renal failure in late pregnancy or postpartum. This case report describes a 26-year-old healthy pregnant woman who underwent an emergency cesarean section at 38 weeks of gestation due to severe preeclampsia and placental abruption. Postoperatively, she rapidly developed persistent hypertension, hemolysis, elevated liver enzymes, and thrombocytopenia, which were initially considered to indicate HELLP (Hemolysis, Elevated Liver enzymes, and Low Platelets) syndrome. However, the patient developed acute renal failure postoperatively, and her condition progressively worsened. After the diagnosis of p-aHUS was finally confirmed, the patient received plasma exchange and eculizumab treatment, resulting in significant clinical improvement.