Thrombotic microangiopathy and renal cortical necrosis in a postpartum patient: A rare and complex presentation

Jenifer

Charge Nurse, Kauvery Hospital, Alwarpet, Chennai

Abstract

This case report describes a 23-year-old postpartum patient who developed thrombotic microangiopathy (TMA) and renal cortical necrosis after a Lower Segment Caesarean Section (LSCS). The patient presented with postpartum hemorrhage, anuria, and ischemic changes over her peripheries. She was managed with dialysis, plasmapheresis, anticoagulation, and antibiotics. This case highlights the importance of prompt recognition and management of postpartum complications, particularly in patients with underlying medical conditions.

Introduction

Thrombotic microangiopathy (TMA) is a rare and life-threatening condition characterized by microangiopathic hemolytic anemia, thrombocytopenia, and renal failure. Renal cortical necrosis is a severe complication of TMA, which can lead to chronic kidney disease. Postpartum patients are at increased risk of developing TMA due to various factors, including hypertension, preeclampsia, and postpartum hemorrhage.

Case Presentation

A 23-year-old lady, was brought to our KCH hospital with postpartum hemorrhage, anuria, and ischemic changes over her peripheries after a Lower Segment Caesarean Section (LSCS) on December 19, 2024. She had a history of hypothyroidism and mildly increased blood pressure during the last 2-3 weeks of antenatal period. Her baseline investigations showed leucopenia, elevated serum creatinine, and deranged liver function tests.

Diagnosis and Management

The patient was diagnosed with thrombotic microangiopathy (TMA) based on her clinical presentation, laboratory findings, and imaging studies. She was managed with dialysis, plasmapheresis, anticoagulation, and antibiotics. Three cycles of plasmapheresis were performed, which resulted in improvement of her platelet count and liver function tests.

Nursing Implications and Interventions

Assessment

  1. Monitored vital signs, including blood pressure, pulse, respiratory rate, and oxygen saturation.
  2. Assessed for signs of bleeding, such as petechiae, ecchymosis, and hematuria.
  3. Monitored laboratory results, including complete blood count, liver function tests, and renal function tests.

Nursing Diagnosis

  1. Risk for bleeding related to thrombocytopenia.
  2. Acute kidney injury related to renal cortical necrosis.
  3. Risk for infection related to immunosuppression.

Interventions

  1. Administered platelet transfusions as ordered.
  2. Monitored for signs of bleeding and report to the physician immediately.
  3. Implemented infection control measures, such as hand hygiene and sterile technique.
  4. Provided emotional support and education to the patient and her family.
  5. Collaborated with the interdisciplinary team to develop a comprehensive plan of care.

Heartfelt Appreciation from the Family

We are delighted to share the heartfelt testimonial from the satisfied patient and their family, who expressed their deepest gratitude for the exceptional care they received.

 

“The entire team took incredible care of us, and we are forever grateful. Our baby’s condition has improved significantly, and we were able to manage their care effectively at home with formula feeding. We were impressed by the kindness, compassion, and professionalism of every staff member we interacted with.”

The family particularly praised staff Aarthi and charge Nurse Jennifer for their “tremendous support” during the patient’s recovery. They appreciated the staff’s commitment to their care, evident in the significant improvement in the patient’s condition, including increased urinary output.

“We were touched by the dedication of the staff, who always took the time to address our concerns and provide reassurance. The fact that the patient’s mother made it a point to visit the staff during each dialysis session is a testament to the strong bond they formed.”

We are proud of our team’s hard work and dedication to delivering exceptional patient care. Thank you to our patients and their families for trusting us with their care.

Complications and Outcome

The patient developed several complications, including renal cortical necrosis, ischemic changes over her peripheries, and a large left perinephric hematoma. She underwent angioembolization, hematoma aspiration, and pigtail insertion. She also developed global myocardial dysfunction, myopericarditis, and moderate pericardial effusion, which were managed with optimal medical management. Which was managed well during her hospitalization. which was significantly shown in increasing urine output.

Conclusion

This case highlights the importance of prompt recognition and management of postpartum complications, particularly in patients with underlying medical conditions. Thrombotic microangiopathy (TMA) and renal cortical necrosis are rare and life-threatening conditions that require aggressive management. A multidisciplinary approach, including obstetricians, nephrologists, hematologists, and vascular surgeons, is essential for optimal management of such complex cases.

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