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November 19, 1982

Postpartum Hemolytic Uremic Syndrome

JAMA. 1982;248(19):2449-2450. doi:10.1001/jama.1982.03330190019013

To the Editor.—  I must submit an objection to the advocacy of the article by Spencer et al. The most immediate criticism of the analysis of efficacy of these plasma-exchange transfusion interventions is the post hoc propter hoc fallacy. Why did the initial plasma infusions "not appear to be of benefit," while subsequent plasma exchange coincide with improvement? The parturient woman in question recovered from her illness because the factor that incited her acute renal failure was eliminated— the pregnancy was terminated. Short of the development of renal cortical necrosis, her eventual full recovery of renal function was ensured.Moreover, the correct renal disorder needs to be identified. The kidney disorder that befell this "preeclamptic patient" was the basic glomerular compromise of systemic paracoagulation, for which women with hypertensive disorders of pregnancy are at risk. Additionally, she was found to have an abrupted placenta, a major cause of the same