Abstract: PUB481
Postpartum Ruptured Sub-Capsular Liver Hematoma with Dialysis-Dependent AKI and Intracranial Bleed with Delayed Recovery: Is It HELLP or aHUS?
Session Information
Category: Trainee Case Reports
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Gupta, Sanjeev, Westchester County Medical Center, Valhalla, New York, United States
- Chugh, Savneek S., New York Medical College, Hartsdale, New York, United States
- Kapoor, Aromma, Westchester County Medical Center, Valhalla, New York, United States
Introduction
HELLP, a known complication of preeclampsia, can rarely result in ruptured sub-capsular liver hematoma (SLH) and very rarely dialysis-dependent AKI. We present a case of preeclampsia complicated by postpartum ruptured SLH and dialysis-dependent AKI with delayed recovery after delivery.
Case Description
A 33-year-old lady with prior two 1st trimester miscarriages admitted for emergent C-section due to fetal bradycardia and preeclampsia. During surgery hemoperitoneum and ruptured SLH was found. The patient developed AKI and anuria the following day. CVVHD was initiated. Lab workup showed low Hb & platelet counts with elevated LFTs & S.ammonia, resulting in a presumed diagnosis of HELLP syndrome. The patient showed minimal recovery post-delivery with supportive treatment. CVVHD was continued. A CT head was performed due to AMS which revealed sub-arachnoid hemorrhage. Due to persistent thrombocytopenia and anemia, further workup for TTP/ aHUS, and APLS were ordered. Schistocytes were seen on peripheral blood with low complement levels and normal ADAMTS 13 activity. A renal biopsy wasn’t done due to thrombocytopenia, however, given high suspicion of aHUS treatment with Eculizumab was considered. Just before the treatment initiation, her platelet count and other lab parameters started to improve so the drug was withheld.
Discussion
HELLP syndrome, APLS, TTP, and aHUS, can clinically mimic each other and it can be very challenging to differentiate, although expedited delivery usually improves HELLP and APLS. ADAMTS 13 is low in TTP but the diagnosis of aHUS is solely based on the clinical picture. Our patient didn’t respond to expedited delivery and ADAMTS 13 was normal. Given delayed recovery, our patient likely had aHUS which fortunately resolved spontaneously. Henceforth, it is important to exclude aHUS when there is minimal or delayed recovery in patients with severe preeclampsia/ HELLP even after the delivery.