Pregnancy-Associated Thrombotic Microangiopathy

Advanced Real-Life Case

Learning objectives: Recognize TMA from thrombocytopenia, hemolysis, and kidney injury; use timing and response to delivery; and coordinate urgent multidisciplinary management.

Clinical Scenario

A 32-year-old at 31 weeks gestation presents with headache, hypertension, thrombocytopenia, anemia, rising creatinine, dark urine, high LDH, undetectable haptoglobin, and schistocytes. ADAMTS13 activity is pending.

Clinical Reasoning

The differential includes preeclampsia with severe features or HELLP, TTP, complement-mediated TMA, and secondary causes. Stabilize the mother, involve maternal-fetal medicine, hematology, nephrology, and critical care, and use the post-delivery trajectory to refine the diagnosis.

Interactive Checkpoints

Complete the case questions to test your clinical reasoning. Detailed explanations are revealed after completion.

Pregnancy-Associated Thrombotic Microangiopathy

Advanced real-life nephrology case. Distinguish pregnancy-associated TMA syndromes using hemolysis, platelet trends, timing, and multidisciplinary priorities.

1 / 5

Which combination establishes a clinical TMA syndrome?

Anemia with low LDH and high haptoglobin

Thrombocytopenia, schistocytes, hemolysis, and organ injury

Proteinuria alone

Hypertension without laboratory abnormalities

TMA is a clinicopathologic syndrome characterized by microangiopathic hemolytic anemia, thrombocytopenia, and ischemic organ injury, often involving the kidney and brain.

2 / 5

Which test is most urgent when TTP is a serious possibility?

ADAMTS13 activity and inhibitor testing obtained before plasma therapy when possible

A fasting glucose level only

Urine culture alone

A lipid profile

ADAMTS13 testing is central to evaluating suspected TTP, but treatment decisions should not be delayed when the clinical probability is high.

3 / 5

Which feature favors complement-mediated TMA over isolated preeclampsia-spectrum disease?

Complete resolution of hemolysis after delivery

Persistent severe AKI and hemolysis after delivery

Normal platelet count throughout

No renal involvement

Persistence or progression of TMA features after delivery raises concern for complement-mediated TMA or another ongoing secondary cause and warrants urgent specialist reassessment.

4 / 5

What is the immediate management principle in severe maternal disease?

Delay stabilization until every antibody result returns

Stabilize the mother, involve multidisciplinary teams, and make an urgent delivery and TMA-treatment plan

Treat only the proteinuria

Avoid obstetric consultation

Maternal stabilization and coordinated obstetric, nephrology, hematology, and critical-care management are essential. The plan must address both the pregnancy and the TMA syndrome.

5 / 5

Which blood-film finding is most characteristic of microangiopathic hemolysis?

Spherocytes only

Schistocytes

Target cells only

Macro-ovalocytes without hemolysis

Schistocytes are fragmented erythrocytes produced by passage through diseased microvasculature and support microangiopathic hemolysis in the appropriate clinical context.

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