{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T15:51:17Z","timestamp":1782489077258,"version":"3.54.5"},"reference-count":13,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,2,27]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:p>Pregnancy can trigger thrombotic microangiopathy (TMA), a condition associated with high morbidity and mortality if treatment is delayed. Timely diagnosis remains challenging, particularly in resource-limited settings due to limited access to specialised assays. We present three cases of maternal TMA admitted to our tertiary care unit located in a developing country. One patient was a known case of hereditary thrombocytopenic purpura. Two other cases presented with TMA post-caesarean section complicated by sepsis and postpartum haemorrhage, respectively, and were diagnosed as pregnancy-associated TMA (likely complement-mediated haemolytic uraemic syndrome). Management decisions were largely based on clinical assessment and a resource-adapted pragmatic approach due to unavailability of specialised assays and eculizumab. All patients were treated with urgent therapeutic plasma exchange. This report emphasises the importance of recognising pregnancy-associated TMAs and tailoring the diagnosing and managing strategies to available resources.<\/jats:p>","DOI":"10.1136\/bcr-2025-269344","type":"journal-article","created":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T10:55:16Z","timestamp":1775645716000},"page":"e269344","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Practical approach to pregnancy-associated thrombotic microangiopathies: navigating diagnostic challenges in resource-limited settings"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2744-8716","authenticated-orcid":false,"given":"Meenupriya","family":"Arasu","sequence":"first","affiliation":[{"name":"Anaesthesiology,Pain Medicine and Critical Care, All India Institute of Medical Sciences New Delhi, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5900-0828","authenticated-orcid":false,"given":"Viswanath","family":"S","sequence":"additional","affiliation":[{"name":"Anaesthesiology,Pain Medicine and Critical Care, All India Institute of Medical Sciences New Delhi, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7852-1231","authenticated-orcid":false,"given":"Rahul Kumar","family":"Anand","sequence":"additional","affiliation":[{"name":"Anaesthesiology,Pain Medicine and Critical Care, All India Institute of Medical Sciences New Delhi, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9800-1367","authenticated-orcid":false,"given":"Vimi","family":"Rewari","sequence":"additional","affiliation":[{"name":"Anaesthesiology,Pain Medicine and Critical Care, All India Institute of Medical Sciences New Delhi, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,4,8]]},"reference":[{"key":"2026062608153929000_19.4.e269344.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1312353"},{"key":"2026062608153929000_19.4.e269344.2","doi-asserted-by":"crossref","DOI":"10.1002\/rth2.12708","article-title":"Thrombotic microangiopathies: An illustrated review","volume":"6","author":"Abou-Ismail","year":"2022","journal-title":"Res Pract Thromb Haemost"},{"key":"2026062608153929000_19.4.e269344.3","doi-asserted-by":"crossref","first-page":"1465","DOI":"10.1007\/s00467-019-04233-7","article-title":"Indian Society of Pediatric Nephrology. Hemolytic uremic syndrome in a developing country: Consensus guidelines","volume":"34","author":"Bagga","year":"2019","journal-title":"Pediatr Nephrol"},{"key":"2026062608153929000_19.4.e269344.4","doi-asserted-by":"crossref","first-page":"2103","DOI":"10.1182\/blood.2020005221","article-title":"Management of thrombotic microangiopathy in pregnancy and postpartum: report from an international working group","volume":"136","author":"Fakhouri","year":"2020","journal-title":"Blood"},{"key":"2026062608153929000_19.4.e269344.5","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1097\/AOG.0000000000005024","article-title":"Differentiating and Managing Rare Thrombotic Microangiopathies During Pregnancy and Postpartum","volume":"141","author":"Lim","year":"2023","journal-title":"Obstet Gynecol"},{"key":"2026062608153929000_19.4.e269344.6","doi-asserted-by":"crossref","first-page":"984","DOI":"10.1182\/blood.2022017860","article-title":"How I diagnose and treat atypical hemolytic uremic syndrome","volume":"141","author":"Fakhouri","year":"2023","journal-title":"Blood"},{"key":"2026062608153929000_19.4.e269344.7","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1016\/j.transci.2011.04.004","article-title":"Early diagnosis and management of postpartum hemolytic uremic syndrome with plasma exchange","volume":"44","author":"Shrivastava","year":"2011","journal-title":"Transfus Apher Sci"},{"key":"2026062608153929000_19.4.e269344.8","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1016\/j.tracli.2021.07.002","article-title":"Challenges in management of atypical hemolytic uremic syndrome: Bottle neck in resource limited settings","volume":"29","author":"Mittal","year":"2022","journal-title":"Transfus Clin Biol"},{"key":"2026062608153929000_19.4.e269344.9","doi-asserted-by":"publisher","DOI":"10.1111\/jth.13882"},{"key":"2026062608153929000_19.4.e269344.10","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1007\/s13312-020-1920-9","article-title":"Guidelines on Hemolytic Uremic Syndrome by Indian Society of Pediatric Nephrology: Key Messages","volume":"57","author":"Khandelwal","year":"2020","journal-title":"Indian Pediatr"},{"key":"2026062608153929000_19.4.e269344.11","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1053\/j.seminhematol.2003.10.003","article-title":"von Willebrand factor, ADAMTS-13, and thrombotic thrombocytopenic purpura","volume":"41","author":"Moake","year":"2004","journal-title":"Semin Hematol"},{"key":"2026062608153929000_19.4.e269344.12","doi-asserted-by":"publisher","DOI":"10.1002\/jca.21705"},{"key":"2026062608153929000_19.4.e269344.13","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1007\/s00467-014-2948-7","article-title":"Effect of plasma exchange and immunosuppressive medications on antibody titers and outcome in anti-complement factor H antibody-associated hemolytic uremic syndrome","volume":"30","author":"Khandelwal","year":"2015","journal-title":"Pediatr Nephrol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-269344","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T15:21:32Z","timestamp":1782487292000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-269344"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":13,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4,8]]},"published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1136\/bcr-2025-269344"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-269344","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]}}}