Severe Postpartum Thrombotic Microangiopathy Presenting with Purpura, Acute Kidney Injury, and Hepatic Dysfunction

Abstract

Background: Severe thrombocytopenia in the postpartum period is a life-threatening condition requiring urgent differentiation between thrombotic thrombocytopenic purpura (TTP), disseminated intravascular coagulation (DIC), and HELLP syndrome. Early recognition significantly impacts survival.

Case Presentation: A 20-year-old previously healthy primiparous woman presented 7 days after spontaneous vaginal delivery with dyspnea, fatigue, abdominal pain, jaundice, and progressive purpuric lesions over both lower extremities. Laboratory evaluation showed severe thrombocytopenia (12,000/μL), anemia (Hb 9 g/dL), leukocytosis (22.83 ×10³/μL), acute kidney injury (creatinine 4.85 mg/dL), elevated liver enzymes (AST 233 U/L, ALT 84 U/L), hyperbilirubinemia (4.57 mg/dL), and near-normal coagulation parameters (INR 1.19). Urinalysis revealed hematuria. Ultrasound demonstrated mild–moderate ascites and increased renal parenchymal echogenicity. The constellation of findings was most consistent with postpartum thrombotic microangiopathy, highly suggestive of TTP.

Conclusion: Postpartum thrombotic microangiopathy should be suspected in patients presenting with severe thrombocytopenia, renal failure, and purpura in the absence of overt coagulopathy. Immediate plasma exchange is critical to reduce mortality.

Keywords: Postpartum thrombocytopenia, Thrombotic thrombocytopenic purpura, T hrombotic microangiopathy, Acute kidney injury, Purpura

Citation

Wondimu AM. Severe Postpartum Thrombotic Microangiopathy Presenting with Purpura, Acute Kidney Injury, and Hepatic Dysfunction. WebLog J Clin Case Rep. wjccr.2026.c2501. https://doi.org/10.5281/zenodo.19309174