Abstract: TH-PO0065
Concomitant Peripartum Hemolysis, Elevated Liver Enzymes, and Low Platelets (HELLP) Syndrome and Pregnancy-Associated Atypical Hemolytic Uremic Syndrome (PA-aHUS): Solving This Diagnostic Dilemma with a Unique Case and Literature Review
Session Information
- AKI: Pathogenesis and Disease Mechanisms
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Vega, Melissa Mia, University of Massachusetts Chan Medical School - Baystate Regional Campus, Springfield, Massachusetts, United States
- Hodgins, Spencer, University of Massachusetts Chan Medical School - Baystate Regional Campus, Springfield, Massachusetts, United States
- Obeidat, Yasin, University of Massachusetts Chan Medical School - Baystate Regional Campus, Springfield, Massachusetts, United States
- Schoen, Corina, University of Massachusetts Chan Medical School - Baystate Regional Campus, Springfield, Massachusetts, United States
- Landry, Daniel L., University of Massachusetts Chan Medical School - Baystate Regional Campus, Springfield, Massachusetts, United States
- Braden, Gregory Lee, University of Massachusetts Chan Medical School - Baystate Regional Campus, Springfield, Massachusetts, United States
Introduction
All peripartum cases of HELLP & PA-aHUS contain the same triad of hemolysis, elevated transaminases & low platelet count. We present a unique case & summary table of the literature to differentiate these conditions.
Case Description
A 39y/o G2P0 W with dichorionic twins developed severe preeclampsia with HELLP at 32 weeks gestation. She had hemolytic anemia, Hb 7 gm/dL, haptoglobin <10 mg/dL, plt 51,000, LDH 3543 U/L, AST 830 U/L, schistocytes, & TP/Cr 3.45 g/g. 1 day after delivery she was oliguric, creatinine (sCr) 3.1 mg/dL & potassium 7.2 meq/L, requiring hemodialysis (HD). At day 4 with continued hemolysis & oliguria, plt was 50,000, she had a low C4 9 mg/dL, normal C3 & ADAMTS-13 activity, negative ANA & APL antibodies, & HD continued. After genetic complement tests were sent, Eculizumab (ECU) 900 mg weekly for 4 weeks was started. 3 days after the 1st ECU dose hemolysis resolved, urine protein decreased & HD was stopped. Genetic studies were negative. ECU was continued, 1200 mg every 2 weeks for 5 months (mos), then weaned & stopped at 10 mos, sCr was 0.84 mg/dL with no proteinuria.
Table 1 contains the data differentiating HELLP & PA-aHUS.
Discussion
We identified PA-aHUS with simultaneous HELLP by the severely elevated LDH > 1832 U/L, sCr > 1.9 mg/dL, persistent hemolysis, low platelet count, & continued AKI 4 d after delivery. In HELLP rapid recovery is noted by day 4 post-partum. Early diagnosis of PA-aHUS in this patient lead to a quick start of ECU & continued for 10 mos despite negative complement mutations. This allowed full renal & hematologic recovery & prevention of renal cortical necrosis, a dire outcome in PA-aHUS. Patients with HELLP persisting for > 4 d should receive ECU.
Table 1
| Parameter | NORMAL PREGNANCY | PREECLAMPSIA | HELLP | PA-aHUS |
| Hemolysis | No | No | 100% | 100% |
| Platelet Count 10^3/μL | >150 | 100-149 | <150 | <100 |
| *LDH IU/L | NL | Mild increase | 600-1832 | >1832 |
| *Serum Creatinine mg/dL | <0.8 | 0.8-1.5 | <1.9 | >1.9 |
| C3 | High | High | Normal | Low (30-60%) |
| C4 | High | High | Low (90%) | NL |
| Complement Mutations | No | Rare | 6-45% | 55-81% |
| Stage 3 AKI | No | 4% | 11% | 90% |
| Recovery | N/A | After Delivery | Within 4 days postpartum | Persistent postpartum |
*Burwick et al, Hypertension. 2021;78(3):760-768