Acquired ADAMTS 13 deficiency as a cause of thrombotic microangiopathy in a pregnant woman with recurrent cerebrovascular disorders, venous thromboembolism, preeclampsia and fetal loss syndrome

Objective. To review an update on the association of thrombotic microangiopathy with thromboses and severe vascular events in pregnancy. To describe a clinical case of management in pregnant patients with a history of recurrent strokes and perinatal losses. Material and methods. The pregnancy management tactics in a patient with recurrent ischemic stroke and anti-ADAMTS 13 antibodies was described. The literary sources on the topic mainly 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, which is characterized by micro-vascular 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 afresh 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.

ADAMTS-13, thrombotic microangiopathy, ADAMTS-13, preeclampsia, fetal loss syndrome