Abstracts of the 3rd Annual Toronto Complement Conference
Bibliographic record
Abstract
Rationale: Pregnancy-associated thrombotic microangiopathy (TMA) comprises a spectrum of primary and secondary conditions.Although pre-eclampsia/HELLP is the predominant cause of pregnancy-TMA, atypical Hemolytic uremic syndrome (aHUS), also known as complement mediated thrombotic microangiopathy (CM-TMA), is an uncommon cause of TMA in pregnancy.Description of treatment and outcomes with eculizumab are limited to <50 case reports.Presenting concerns of the patient: 28-year-old female with a significant medical history who is presenting hours after the uncomplicated vaginal delivery of her first child with microangiopathic hemolytic anemia (MAHA), thrombocytopenia, elevated liver enzymes and elevated serum creatinine.Diagnoses: Prior to delivery, there were no signs of hypertension or proteinuria that would suggest evolving pre-eclampsia.The initial diagnosis was that of acute fatty liver disease of pregnancy and pre-eclampsia.As the renal injury continued to worsen without improvement in anemia and thrombocytopenia, aHUS became the predominant differential.ADAMTS13 and anti-phospholipid antibody syndrome (APLAS) screen were negative.Serum C3 was found to be low.Genetic complement screen was negative.Intervention: Treatment included anti-C5 inhibition with eculizumab.After receiving weekly induction doses, they were transitioned to and remain on eculizumab every 2 weeks.Outcomes: Liver enzymes had improved prior to initiation of eculizumab.There was normalization of hematological parameters after initiation of eculizumab therapy.They currently remain dialysis dependent, but recently urine output has returned.Teaching Points: Diagnosis of aHUS in pregnancy is one of exclusion.Development of MAHA, thrombocytopenia, and kidney injury in the post-partum period, with negative serologies for TTP/APLAS, and failure to improve after 24-72 hours should raise the suspicion of aHUS.Prompt diagnosis is needed for timely initiation of anti-complement therapy.This is one of the first descriptions in North America of aHUS presenting post-partum treated with eculizumab.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.005 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.696 | 0.388 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; the direct Gemma label and the distilled Codex classifier agree on what is shown here.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".