Microangiopathic hemolytic anemia may occur in woman who are or who have been recently pregnant. Identification of the cause is important for management and for future pregnancies.
Causes of microangiopathic microcytic anemia associated with pregnancy:
(1) hypertension of pregnancy
(2) preeclampsia
(3) HELLP syndrome
(4) acute fatty liver of pregnancy (AFLP)
(5) placental abruption
(6) SLE with lupus nephritis
(7) vasculitis
(8) antiphospholipid syndrome (APLS)
(9) sepsis
(10) severe hemorrhage
(11) TTP, especially congenital, including the Upshaw-Schulman Syndrome
(12) atypical HUS (complement-dependent HUS)
(13) other causes of DIC
Clues:
(1) TTP may present in the first trimester.
(2) Postpartum onset of the anemia favors sepsis, TTP or atypical HUS.
(3) The hemolysis in HELLP is often mild.
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