Severe forms of preeclampsia as a manifestation of thrombotic microangiopathy


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Abstract

Objective. To present and analyze an update on a relationship of thrombotic microangiopathy to severe vascular complications during pregnancy. Material and methods. The literary sources on the topic during the last 10 years, which had been found in the Pubmed and Medline databases, were analyzed. Results. Thrombotic microangiopathy is one of the most severe thrombotic events that are characterized by microvascular lesions in various organs and accompanied by thrombocytopenia and hemolytic anemia. The term thrombotic microangiopathy encompasses several nosological entities characterized by different mechanisms of microthrombosis. At present, thrombotic microangiopathy includes thrombotic thrombocytopenic purpura, hemolytic uremic syndrome, heparin-induced thrombocytopenia, and HELLP syndrome. Pregnancy is one of the most important triggers of thrombotic microangiopathy. This fact opens up broad prospects for studying the pathogenesis of thrombotic microangiopathy in the context of physiological changes in hemostasis during pregnancy. Conclusion. The discovery of molecular mechanisms of thrombotic microangiopathy allows a fresh look at the pathogenesis of thrombotic events associated with pregnancy and at that of the so-called placental obstetric complications, including the severe forms of preeclampsia.

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About the authors

Alexander Davidovich Makatsaria

I.M. Sechenov First Moscow State Medical University

Email: gemostasis@mail.ru
MD, professor, corresponding member of RAMS, the head of Department of Obstetrics and Gynecology of the Faculty of Medicine and Prevention

Victoria Omarovna Bitsadze

I.M. Sechenov First Moscow State Medical University

Email: gemostasis@mail.ru
MD, professor of the Department of Obstetrics and Gynecology of the Faculty of Medicine and Prevention

Svetlana Vladimirovna Akinshina

I.M. Sechenov First Moscow State Medical University

Email: gemostasis@mail.ru
Ph.D., scientific employee of the Department of Obstetrics and Gynecology of the Medical-Prophylactic Faculty

References

  1. Kentouche K., Voigt A., Schleussner E., Schneppenheim R., Budde U., Beck J.F. et al. Pregnancy in Upshaw-Schulman syndrome. Hamostaseologie. 2013; 33(2): 144-8.
  2. Torok T.J., Holman R.C., Chorba T.L. Increasing mortality from thrombotic thrombocytopenic purpura in the United States-analysis of national mortality data, 1968-1991. Am. J. Hematol. 1995; 50(2): 84-90.
  3. Furlan M., Lammle B. Aetiology and pathogenesis of thrombotic thrombocytopenic purpura and haemolytic uraemic syndrome: the role of von Willebrand factor-cleaving protease. Best Pract. Res. Clin. Haematol. 2001; 14(2): 437-54.
  4. Ruggenenti P., Noris M., Remuzzi G. Thrombotic microangiopathy, hemolytic uremic syndrome, and thrombotic thrombocytopenic purpura. Kidney Int. 2001; 60(3): 831-46.
  5. Sibai B.M., Ramadan M.K., Usta I., Salama M., Mercer B.M., Friedman S.A. Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome) Am. J. Obstet. Gynecol. 1993; 169(4): 1000-6.
  6. O’Brien J.M., Barton J.R. Controversies with the diagnosis and management of HELLP syndrome. Clin. Obstet. Gynecol. 2005; 48(2): 4 60-77.
  7. Moake J.L., Rudy C.K., Troll J.H., Weinstein M.J., Colannino N.M., Azocar J. et al. Unusually large plasma factor VIII: vonWillebrand factor multimers in chronic relapsing thrombotic thrombocytopenic purpura. N. Engl. J. Med. 1982; 307(23): 1432-5.
  8. Raife T., Montgomery R. New aspects in the pathogenesis and threatment of thrombotic thrombocytopenic purpura and hemolytic uremic syndrome. Rev. Clin. Exp. Hematol. 2001; 5(3): 536-61.
  9. Lämmle B., Kremer Hovinga J., Studt J.D., Mansouri Taleghani B., Alberio L. Thrombotic thrombocytopenic purpura. Hematol. J. 2004; 5(Suppl. 3): S6-11.
  10. Schaller M., Studt J.D., Voorberg J., Kremer Hovinga J.A. Acquired thrombotic thrombocytopenic purpura. Development of an autoimmune response. Hamostaseologie. 2013; 33(2): 121-30.
  11. Furlan M. Deficient activity of von Willebrand factor-cleaving protease in thrombotic thrombocytopenic purpura. Expert Rev. Cardiovasc. Ther. 2003; 1(2): 243-55.
  12. George J.N. Thrombotic thrombocytopenic purpura: a syndrome that keeps evolving. J. Clin. Apheresis. 2004; 19(2): 63-5.
  13. McCrae K.R., Cines D.B. Thrombotic microangiopathy during pregnancy. Semin. Hematol. 1997; 34(2): 148-58.
  14. Серов В.Н., Сухих Г.Т., Баранов И.И., Пырегов А.В., Тютюник В.Л., Шмаков Р.Г. Неотложные состояния в акушерстве. М.: ГЭОТАР-Медиа; 2011. [Serov V.N., Sukhikh G.T., Baranov I.I., Pyregov A.V., Tyutyunik V.L., Shmakov R.G. Emergency conditions in obstetrics. Moscow: GEOTAR-Media; 2011. (in Russian)]
  15. Серов В.Н. Профилактика материнской смертности. Акушерство и гинекология. 2011; 7-1: 4-10. [Serov V.N. Prevention of maternal mortality. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2011; (7-1): 4-10. (in Russian)
  16. Katz V.L., Farmer R., Kuller J.A. Preeclampsia into eclampsia: towards a new paradigm. Am. J. Obstet. Gynecol. 2000; 182(6): 1389-94.
  17. Koenig M., Roy M., Baccot S., Cuilleron M., de Filippis J.P., Cathébras P. Thrombotic microangiopathy with liver, gut, and bone infarction (catastrophic antiphospholipid syndrome) associated with HELLP syndrome. Clin. Rheumatol. 2005; 24(2): 166-8.
  18. Klonizakis P. ADAMTS-13 metalloprotease abnormalities in systemic lupus erythematosus: is there a correlation with disease status? Lupus. 2013; 22(5): 443-52.
  19. Pourrat O., Coudroy R., Pierre F. ADAMTS13 deficiency in severe postpartum HELLP syndrome. Br. J. Haematol. 2013; 163(3): 409-10.
  20. Austin S.K., Starke R.D., Lawrie A.S., Cohen H., Machin S.J., Mackie I.J. The VWF/ADAMTS13 axis in antiphospholipid syndrome: ADAMTS13 antibodies and ADAMTS13 dysfunction. Br. J. Haematol. 2008; 141(4): 536-44.
  21. Bell W.R., Kickler T.S. Thrombocytopenia in pregnancy. Rheum. Dis. Clin. North Am. 1997; 23(1): 183-94.
  22. Rock G.A., Shumak K.H., Buskard N.A., Blanchette V.S., Kelton J.G., Nair R.C., Spasoff R.A. Comparison of plasma exchange with plasma infusion in the treatment of thrombotic thrombocytopenic purpura. Canadian Apheresis Study Group. N. Engl. J. Med. 1991; 325(6): 393-7.
  23. Isler C.M., Barrilleaux P.S., Magann E.F., Bass J.D., Martin J.N. Jr. A prospective, randomized trial comparing the efficacy of dexamethasone and betamethasone for the treatment of antepartum HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. Am. J. Obstet. Gynecol. 2001; 184(7): 1332-9.

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