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November 19, 1982

Postpartum Hemolytic Uremic Syndrome

JAMA. 1982;248(19):2449. doi:10.1001/jama.1982.03330190019012

To the Editor.—  My compliments to Spencer et al for an excellent clinical outcome by the use of plasma exchange in a female patient thought to have postpartum hemolytic uremic syndrome (HUS) (1982;247:2808). Unfortunately, the authors have fallen into the clinical trap of describing the trees but missing the forest.The condition present in their patient is a variant of severe preeclampsia comprised of microangiopathic hemolytic anemia, which caused the hemolysis (H), elevated levels of liver enzymes (EL), and thrombocytopenia (LP indicates low platelet count).1 The term HELLP syndrome has been given to this compilation of symptoms that may occur ante partum or post partum. The treatment described of plasma exchange has been used at the University of Arizona, Tucson, as well as by other investigators.2The various forms of preeclampsia are often misdiagnosed, resulting in excessive perinatal and maternal morbidity and mortality.3 The clinician who is