一例未确诊的产后溶血性尿毒症综合征病例报告。
A case report of undiagnosed postpartum hemolytic uremic syndrome.
作者信息
Mu Jiao, Zhang Ji, Sunnassee Ananda, Dong Hongmei
机构信息
Department of Forensic Medicine, Tongji Medical College of Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, Hubei, 430030, PR China.
Department of Phatology, Hebei North University, No. 11 Zuanshinan Road, Zhangjiakou, Hebei, 075000, PR China.
出版信息
Diagn Pathol. 2015 Jul 8;10:89. doi: 10.1186/s13000-015-0278-0.
BACKGROUND
Postpartum hemolytic uremic syndrome (PHUS) is a severe thrombotic microangiopathy (TMA) that is clinically characterized by hemolytic anemia, renal dysfunction, and low platelet levels after childbirth. Here, we report a rare case of unexpected death due to PHUS.
CASE PRESENTATION
A 23-year-old parturient had an uncomplicated cesarean section at 40 weeks gestation. The immediate postpartum course was uneventful. However, eight days post delivery, the patient developed severe nausea and vomiting followed by hematuria, spontaneous bruising, marked pallor, icteric sclera, and lethargy. Laboratory findings revealed that the patient had hemolytic anemia, thrombocytopenia, and acute renal failure. This patient died approximately 29 h after the onset of symptoms. Post-mortem examination confirmed that the patient had PHUS.
CONCLUSIONS
This paper addresses the need for a renal histological examination in addition to a thorough clinical history and appropriate laboratory tests for the rapid and accurate diagnosis of PHUS. Early detection and diagnosis can significantly improve the prognosis and optimize maternal outcomes.
背景
产后溶血性尿毒症综合征（PHUS）是一种严重的血栓性微血管病（TMA），其临床特征为产后出现溶血性贫血、肾功能不全和血小板水平降低。在此，我们报告一例因PHUS导致意外死亡的罕见病例。
病例介绍
一名23岁产妇在妊娠40周时行无并发症剖宫产。产后即刻过程顺利。然而，产后第8天，患者出现严重恶心、呕吐，随后出现血尿、自发性瘀斑、明显苍白、巩膜黄染和嗜睡。实验室检查结果显示患者患有溶血性贫血、血小板减少症和急性肾衰竭。该患者在症状出现后约29小时死亡。尸检证实患者患有PHUS。
结论
本文强调除了详细的临床病史和适当的实验室检查外，还需要进行肾脏组织学检查，以快速准确地诊断PHUS。早期发现和诊断可显著改善预后并优化孕产妇结局。
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