A 31-year-old woman who is 25-weeks pregnant is brought to the Emergency Department by her husband. Over the past two days she has become increasingly confused. Her temperature is 37.8ºC and blood pressure is 104/62 mmHg. Blood tests show:
Hb-8.3 g/dl
Platelets-88 * 109/l
WBC-15.1 * 109/l
Blood film-Fragmented red blood cells
Sodium-139 mmol/l
Potassium-5.2 mmol/l
Urea-19.4 mmol/l
Creatinine-296 µmol/l
What is the most appropriate treatment?
Rituximab
Intravenous immunoglobulin
Methylprednisolone
Ceftriaxone + vancomycin
Plasma exchange