Postpartum hemolytic uremic syndrome

Abstract

A 22-year-old. gravida 1, para 1, abortus 1 woman was readmitted to the hospital with abdominal pain, vomiting, and bloody diarrhea of 2 days' duration. Pregnancy had been uncomplicated; blood pressure readings and urinalyses showed normal results. Labor and delivery at 39 weeks' gestation had been uncomplicated, and the patient had been discharged on the third postpartum day. Examination at readmission on the fifth postpartum day revealed diffuse abdominal tenderness with rebound and hypoactive bowel sounds. The patient was afebrile, and results of a test for occult blood in the stool were positive. Laboratory data included hematocrit, 48%; platelet count, 67,000/mm3 ; white blood cell count, 21 ,300/mm3 ; creatinine, 1.0 mg/dl; normal electrolyte count; urinalysis results showing protein uria (4+), 13 to 20 white blood cells per high-power field, 15 to 20 red blood cells per high-power field, and hyaline and granular casts. A coagulation profile revealed a normal fibrinogen level (308 mg/dl), a normal prothrombin time (12.5 seconds), normal protamine sulfate test results, and elevated fibrin split products (10 to 40 ng/ml). AsCites was present on x-ray evaluation of the abdomen. Cultures of urine, blood, stool, and ascitic fluid showed no growth. During the first 5 days after admission the hematocrit de-