Practical approach to pregnancy-associated thrombotic microangiopathies: navigating diagnostic challenges in resource-limited settings

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.