Features of TMA associated with PPH complicated by RCN
| PPH and TMA . |
|---|
| 1. PPH (defined as blood loss >500 mL) may be associated with AKI resulting from hypovolemia, colloid infusion, or disseminated intravascular coagulation. |
| 2. More rarely, AKI-associated with PPH may have features of TMA (hemolytic anemia and severe thrombocytopenia). |
| In this context, especially in anuria/severe oliguria, RCN40 (irreversible ischemic necrosis of the renal cortex) should be ruled out (ideally using magnetic resonance imaging, or alternatively Doppler ultrasound) in order to avoid unnecessary treatments (plasma exchange, complement inhibitor). |
| 3. In a recent report of 18 cases of PPH complicated with RCN,40all patients had hemolytic anemia and AKI requiring dialysis. |
| Hemolysis and thrombocytopenia resolved within 7 d without specific treatment; 8 patients remained dialysis-dependent and 10 had chronic kidney disease. |
| 4. The potential role of a high dose (>2 g) and prolonged administration of tranexamic acid in the context of a “gravid endothelium” has been suggested.40 |
| (Tranexamic acid is an antifibrinolytic drug, which induces experimental TMA in rats).52 |
| 5. Nevertheless, PPH is a life-threatening complication of pregnancy and the WOMAN study53demonstrates a significant decrease of death due to bleeding in patients treated with tranexamic acid (first dose of 1 g with a possible second dose of 1 g, 30 min later) for PPH without renal side effects. |
| PPH and TMA . |
|---|
| 1. PPH (defined as blood loss >500 mL) may be associated with AKI resulting from hypovolemia, colloid infusion, or disseminated intravascular coagulation. |
| 2. More rarely, AKI-associated with PPH may have features of TMA (hemolytic anemia and severe thrombocytopenia). |
| In this context, especially in anuria/severe oliguria, RCN40 (irreversible ischemic necrosis of the renal cortex) should be ruled out (ideally using magnetic resonance imaging, or alternatively Doppler ultrasound) in order to avoid unnecessary treatments (plasma exchange, complement inhibitor). |
| 3. In a recent report of 18 cases of PPH complicated with RCN,40all patients had hemolytic anemia and AKI requiring dialysis. |
| Hemolysis and thrombocytopenia resolved within 7 d without specific treatment; 8 patients remained dialysis-dependent and 10 had chronic kidney disease. |
| 4. The potential role of a high dose (>2 g) and prolonged administration of tranexamic acid in the context of a “gravid endothelium” has been suggested.40 |
| (Tranexamic acid is an antifibrinolytic drug, which induces experimental TMA in rats).52 |
| 5. Nevertheless, PPH is a life-threatening complication of pregnancy and the WOMAN study53demonstrates a significant decrease of death due to bleeding in patients treated with tranexamic acid (first dose of 1 g with a possible second dose of 1 g, 30 min later) for PPH without renal side effects. |
PPH, postpartum hemorrhage.