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Postoperatively, she required several units of human albumin solution, red blood cell transfusions and octaplex (prothrombin complex) to prevent further bleeding. An inpatient haematology review revealed a hypocomplementaemia (C3\/C4), low immunoglobulin (IgG, IgM, IgA) and peripheral blood films revealed schistocytosis indicating microangiopathic haemolytic anaemia. Bowel histology supported this, demonstrating circumferential lymphocytic phlebitis with thrombi and mucosal haemorrhage, necrosis and ulceration. The patient went on to suffer multiple ischaemic strokes before undergoing plasmapheresis, subsequent rehabilitation and making a successful recovery.<\/jats:p>","DOI":"10.1136\/bcr-2019-230553","type":"journal-article","created":{"date-parts":[[2019,11,28]],"date-time":"2019-11-28T10:45:13Z","timestamp":1574937913000},"page":"e230553","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["A case of thrombotic microangiopathy of unknown aetiology, clinically presenting as an acute surgical abdomen"],"prefix":"10.1136","volume":"12","author":[{"given":"Lydia Madeleine Isabel","family":"Stratford","sequence":"first","affiliation":[{"name":"Medical School, University of Birmingham, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isaac","family":"Nahoor","sequence":"additional","affiliation":[{"name":"Respiratory, Russells Hall Hospital, Dudley, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kataryna","family":"Dos Santos","sequence":"additional","affiliation":[{"name":"General Medicine Department, Russells Hall Hospital, Dudley, West Midlands, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio Alves","family":"Dos Santos","sequence":"additional","affiliation":[{"name":"Upper Gastro-Intestinal Surgery, Russells Hall Hospital, Dudley, West Midlands, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,11,28]]},"reference":[{"key":"2025082713053244000_12.11.e230553.1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2141.2012.09167.x"},{"key":"2025082713053244000_12.11.e230553.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1312353"},{"key":"2025082713053244000_12.11.e230553.3","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1111\/nep.13234","article-title":"Consensus opinion on diagnosis and management of thrombotic microangiopathy in Australia and New Zealand","volume":"23","author":"Fox","year":"2018","journal-title":"Nephrology"},{"key":"2025082713053244000_12.11.e230553.4","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2016-11-743104"},{"key":"2025082713053244000_12.11.e230553.5","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1016\/j.mayocp.2016.05.015","article-title":"Thrombotic microangiopathy care pathway: a consensus statement for the Mayo clinic complement alternative Pathway-Thrombotic microangiopathy (CAP-TMA) Disease-Oriented group","volume":"91","author":"Go","year":"2016","journal-title":"Mayo Clin Proc"},{"key":"2025082713053244000_12.11.e230553.6","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.326.7403.1372"},{"key":"2025082713053244000_12.11.e230553.7","doi-asserted-by":"publisher","DOI":"10.4161\/org.7.1.14027"},{"key":"2025082713053244000_12.11.e230553.8","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1007\/BF01696619","article-title":"Thrombotic thrombocytopenic purpura\/hemolytic uremic syndrome: a multivariate analysis of factors predicting the response to plasma exchange","volume":"70","author":"Pereira","year":"1995","journal-title":"Ann Hematol"},{"key":"2025082713053244000_12.11.e230553.9","first-page":"5","article-title":"Eculizumab safely reverses neurologic impairment and eliminates need for dialysis in severe atypical hemolytic uremic syndrome","volume":"3","author":"Ohanian","year":"2011","journal-title":"Clin Pharmacol"},{"key":"2025082713053244000_12.11.e230553.10","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1093\/ndt\/gfw453","article-title":"Eculizumab in secondary atypical haemolytic uraemic syndrome","volume":"32","author":"Cavero","year":"2017","journal-title":"Nephrol Dial Transplant"},{"key":"2025082713053244000_12.11.e230553.11","doi-asserted-by":"publisher","DOI":"10.1007\/s00467-011-1944-4"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2019-230553","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T20:05:36Z","timestamp":1756325136000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2019-230553"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,11]]},"references-count":11,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2019,11,28]]},"published-print":{"date-parts":[[2019,11]]}},"alternative-id":["10.1136\/bcr-2019-230553"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2019-230553","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2019,11]]}}}