Atypical hemolytic uremic syndrome in the postpartum period

Background: Atypical hemolytic uremic syndrome (aHUS) may present in either the antepartum or postpartum period and is often indistinguishable from other pregnancyassociated diseases. Timely recognition and appropriate treatment can greatly reduce maternal morbidity and mortality. Cases: This case series describes two cases of aHUS in the post-partum period, the difficulty in distinguishing the diagnosis, and the implementation of appropriate treatment with eculizumab, a terminal complement inhibitor. Conclusion: As a terminal complement inhibitor, eculizumab, has been shown to significantly improve clinical and long term renal outcomes, early diagnosis of aHUS is increasingly important. These two cases of aHUS demonstrate the path of accurate diagnosis and timely initiation of therapy to maximize the possibility of patient recovery. Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, IA Introduction This case series describes atypical hemolytic uremic syndrome (aHUS), a rare complication in the post-partum period, which may lead to lifelong complications or even maternal mortality. Clinical signs and laboratory findings may make the diagnosis difficult due to similarities with other post-partum processes such as acute fatty liver of pregnancy (AFLP), hemolytic anemia, elevated liver enzymes, and low platelets (HELLP) syndrome and thrombotic thrombocytopenic purpura (TTP). The importance of placing aHUS on the differential in the antepartum and postpartum period is paramount for obstetricians, and care of these patients requires a multi-disciplinary approach. Newer therapies and possible genetic variants contributing to aHUS have improved outcomes and directed further care for patients. Expeditious diagnosis and implementation of therapy or referral to a center that can provide care can be the difference between life or Proceedings in Obstetrics and Gynecology, 2019;9(1):3 aHUS in the postpartum period 2 death for these patients.