Post-Partum Renal Failure with Microangiopathic Haemolytic Anaemia

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Abstract
Five cases of acute post-partum renal failure with microangiopathic haemolytic anaemia are reported. In 4 patients the pregnancy had been complicated by preeclampsia or frank eclampsia, and in 1 patient the symptoms appeared some days after caesarean section performed beyond the term of a normal pregnancy. The presence of intravascular coagulation was indicated by thrombocytopenia, increase in fibrin degradation products in the serum, and by the finding on renal biopsy of intra-arteriolar and intraglomerular thrombosis. All the patients were given anticoagulant therapy (heparin alone or with dipyridamole). One patient died after 40 days with no improvement in the haematological or renal symptoms. The remaining 4 cases showed an improvement in renal function, and the haemolytic anaemia resolved. Control renal biopsy performed in 3 cases after varying intervals showed fibrous thickening of the intima of the arterioles and interlobular arteries. Anticoagulant therapy was continued over a prolonged period with the object of preventing further deposition of fibrin and platelet aggregation on the arteriolar lesions. The surviving patients have remained in good health for 38, 27, 20 and 6 months, respectively, after the delivery. These results should confirm the utility of anticoagulant therapy in microangiopathic haemolytic anaemia with renal failure, occurring during or after pregnancy.

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