ABSTRACT
Microthrombi formation and hemolytic anemia are signs of hemolytic-uremic syndrome [HUS] that result from platelet consumption and red blood cell [RBC] destruction due to vascular damage. HUS manifests as a triad of signs: micro-angiopathic hemolytic anemia, thrombocytopenia, and uremia. Prenatal asphyxia [PA] also leads to renal insufficiency and vascular damage. There is an overlap between the clinical presentation of PA and neonatal atypical HUS. We have reported the case of a neonate with a primary diagnosis of PA and clinical presentation of acute renal failure [ARF], anemia [Hb = 10 g/dl] and thrombocytopenia [Plt = 80000]. His APGAR scores were 1 [1 minute], 3 [5 minutes], and 7 [10 minutes]. A peripheral blood smear [PBS] was performed, which contained schistocytes [32%] with helmet and burr cells. The neonate's cord blood gas values were: pH of 7.07, HCO[3] = 11mmol/L, and CO[2] = 57mmHg. The first two days of life, he was anuric with elevated BUN and Cr [2.1mg/dL] levels. Complement [C3] was within normal limits at 0.65 g/L [0.89-1.87 g/L], however C4 was below the lower limit of normal at 0.14 g/L [0.16-0.38 g/L]. We ruled out other causes of PA such as maternal illness, placenta abnormalities and infections [TORCH]. We hypothesized that atypical neonatal HUS can progress to PA because of the presence of severe anemia and microthrombi formation