Abstract
A 27-year-old pregnant woman was admitted because of ankle edema and bleeding tendency of sudden onset at 27 weeks of gestation. On physical examination, her blood pressure was 168/108 mmHg and many purpuras were noted on her extensor side of extremities. Proteinuria (4.5 g/day) and microscopic hematuria were present. Red blood cell count was 250×104/mm3, platelet count 1.7×104/mm3, Hb 7.5 g/dl, Ht 25% and reticulocyte 4.5%. Serum Fe was 85 μg/dl. Direct and indirect Coombs' test were negative. Many fragmented red blood cells were noted on peripheral blood smear. With the presumptive diagnosis of microangiopathic hemolytic anemia associated with pre-eclampsia, she was treated by daily infusion of 10,000 U of heparin and 48,000 U of urokinase. Four hundred of fresh blood was transfused. Overt bleeding tendency, platelet count, severity of anemia and proteinuria responded only partially. After she had her pregnancy terminated by Caeasarian section at 29 weeks of gestation, she recovered completely. Renal biopsy performed five months after clinical recovery showed mild endocapillary proliferation with remarkable fibrin deposits along the capillary wall of glomeruli.
The authors suggest that the present case was pre-eclampsia with intravascular coagulation following microangiopathic hemolytic anemia. The fact that the heparin and urokinase appeared to improve the proteinuria and bleeding tendency in this patient suggests the usefulness of these drugs on such a condition.
