Hu Chengjun, Zhang Ping, Xu Qi, Qin Rujuan, Chen Weifeng, Shi Zhen, Chen Ping, Xu Maozhong
Department of Hematology, The Affiliated Jiangyin Hospital of Nantong University, Jiangyin, Jiangsu, China.
Suzhou Jsuniwell Medical Laboratory, Suzhou, China.
Mol Immunol. 2025 Sep;185:1-5. doi: 10.1016/j.molimm.2025.07.002. Epub 2025 Jul 11.
Pregnancy-associated hemolytic uremic syndrome (P-aHUS) is characterized by microvascular hemolytic anemia, thrombocytopenia, and acute organ damage, particularly acute kidney injury, occurring during pregnancy or in the postpartum period. This rare disease has been associated with mutations in genes that regulate the complement system in most reported cases. This article introduces a 38-year-old maternal, who gave birth again after 13 years. Approximately four days post-cesarean section, she developed severe anemia, thrombocytopenia, renal impairment, and abnormal liver function, prompting urgent symptomatic treatment by the doctor. Subsequent detections revealed decreased complement C3 levels, a negative result for the ADAMTS13 inhibitory antibody, and a negative stool culture for bacterial fungi. The diagnosis of P-aHUS was confirmed, and the condition was successfully managed with complement blockade therapy using Eculizumab. Genetic sequencing of the complement factor H (CFH) gene revealed the c.3643 C > T mutation (p.Arg1215*), indicating the presence of rare CFH gene variants that may contribute to the patient's condition. These findings elucidate the clinical manifestations and treatment responses associated with the rare disease P-aHUS in relation to specific gene mutations. We underscore the significance of genetic testing for accurate diagnosis and personalized treatment, offering new insights and evidence for the future clinical management and research of similar cases.
妊娠相关溶血尿毒综合征(P-aHUS)的特征是微血管性溶血性贫血、血小板减少以及急性器官损伤,尤其是在妊娠期间或产后发生的急性肾损伤。在大多数报告病例中,这种罕见疾病与调节补体系统的基因突变有关。本文介绍了一位38岁的产妇,她在13年后再次分娩。剖宫产术后约四天,她出现了严重贫血、血小板减少、肾功能损害和肝功能异常,医生对其进行了紧急对症治疗。随后的检测显示补体C3水平降低、ADAMTS13抑制抗体检测结果为阴性、粪便细菌真菌培养结果为阴性。P-aHUS诊断得以确诊,并使用依库珠单抗进行补体阻断治疗成功控制了病情。补体因子H(CFH)基因的基因测序显示存在c.3643 C>T突变(p.Arg1215*),表明存在可能导致患者病情的罕见CFH基因变异。这些发现阐明了与罕见疾病P-aHUS相关的临床表现和治疗反应与特定基因突变的关系。我们强调基因检测对于准确诊断和个性化治疗的重要性,为未来类似病例的临床管理和研究提供了新的见解和证据。