THROMBOTIC MICROANGIOPATHY IN THE PATHOGENESIS OF OBSTETRIC COMPLICATIONS

S. V. Akinshina; V. O. Bitsadze; Z. K. Gadaeva; A. D. Makatsariya

doi:10.17749/2070-4968.2015.9.2.062-71

THROMBOTIC MICROANGIOPATHY IN THE PATHOGENESIS OF OBSTETRIC COMPLICATIONS

S. V. Akinshina, V. O. Bitsadze, Z. K. Gadaeva, A. D. Makatsariya

https://doi.org/10.17749/2070-4968.2015.9.2.062-71

Full Text:

PDF (Rus)

Abstract

Thrombotic microangiopathy is one of the most serious thrombotic complications characterized by microvascular thrombosis in various organs and accompanied by thrombocytopenia and hemolytic anemia. The term thrombotic microangiopathy has incorporated several nosology, which are characterized by different mechanisms of microvascular thrombosis. Currently thrombotic microangiopathy include thrombotic thrombocytopenic purpura (TTP), hemolytic uremic syndrome (HUS), heparin-induced thrombocytopenia, HELLP-syndrome. Pregnancy presents one of the key triggers to the development of thrombotic microangiopathy. This fact gives us a significant opportunity to study the pathogenesis of thrombotic microangiopathy in the context of the physiological changes of hemostasis during pregnancy. At the same time the discovery of molecular mechanisms of thrombotic microangiopathy allows for a new research on the field of pathogenesis of thrombotic complications associated with pregnancy, as well as the pathogenesis of so-called placental obstetric complications, including severe preeclampsia, premature detachment of normally situated placenta, septic shock.

Keywords

thrombotic microangiopathy, preeclampsia , HELLP-syndrome, maternal mortality

About the Authors

S. V. Akinshina

First Moscow State Medical Sechenov University of the Ministry of Health Russian Federation
Russian Federation
MD, PhD, research associate of the Ob/Gyn Department

V. O. Bitsadze

First Moscow State Medical Sechenov University of the Ministry of Health Russian Federation
Russian Federation
MD., Professor, Department of Obstetrics and Gynecology

Z. K. Gadaeva

First Moscow State Medical Sechenov University of the Ministry of Health Russian Federation
Russian Federation
MD, research associate of the Ob/Gyn Department of

A. D. Makatsariya

First Moscow State Medical Sechenov University of the Ministry of Health Russian Federation
Russian Federation
MD, corresponding member of the Russian Academy of Sciences, Professor, Head of the Department of Obstetrics and Gynecology

References

1. 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 May; 141 (4): 536-44

2. Bell W.R., Kickler T.S. Thrombocytopenia in pregnancy. Rheum Dis Clin North Am. 1997; 23 (1): 183-94.

3. Eerenberg E.S., Levi M. The potential therapeutic benefit of targeting ADAMTS13 activity. Semin Thromb Hemost. 2014 Feb; 40 (1): 28-33.

4. 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.

5. Furlan M. Deficient activity of von Willebrand factor-cleaving protease in thrombotic thrombocytopenic purpura. Expert Rev Cardiovasc Ther. 2003; 1 (2): 243-55.

6. George J.N. Thrombotic thrombocytopenic purpura: a syndrome that keeps evolving. J Clin Apheresis. 2004; 19 (2): 63-5.

7. Isler C.M., Barrilleaux P.S., Magann E.F. et al. 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. Amer. J. Obstet. Gynec. 2001; 184: 1332-9.

8. Katz V.L., Farmer R., Kuler J.A. Preeclampsia into eclampsia: Towards a new paradigm. Amer. J. Obstet. Gynec. 2000; 182: 1389- 94.352.

9. Kentouche K., Voigt A., Schleussner E., Schneppenheim R., Budde U., Beck J.F., Stefańska-Windyga E., Windyga J. Pregnancy in Upshaw-Schulman syndrome. Hamostaseologie. 2013 May 29; 33 (2): 144-8.

10. Klonizakis P. ADAMTS-13 metalloprotease abnormalities in systemic lupus erythematosus: is there a correlation with disease status? Lupus. 2013 Apr; 22 (5): 443-52.

11. Knöbl PN. Treatment of thrombotic microangiopathy with a focus on new treatment options. Hamostaseologie. 2013 May 29; 33 (2): 149-59.

12. Koenig М., Roy М., Baccot S. et al. Thrombotic microangiopathy with liver, gut, and bone infarction (catastrophic antiphospholipid syndrome) associated with HELLP syndrome. Clin. Rheumatol. 2005; 24 (2): 166-

13. Lammle B., Kremer J., Studt J.D. et al. Thrombotic thrombocytopenic purpura. Hematol J. 2004; 5 (3): 6-11.

14. Lammle R., Hovinga J. A. K., Alberio L. Thrombotic thrombocytopenic purpura. J of Thrombosis and Haemostasis. 2005; 3: 1663-1675.

15. McCrae K.R., Cines D.B. Thrombotic microangiopathy during pregnancy. Semin Hematol. 1997; 34 (2): 148-58.

16. Moake J.L., Rudy C.K., Troll J.H. et al. Unusually large plasma factor VIII: vonWillebrand factor multimers in chronic relapsing thrombotic thrombocytopenic purpura. N Eng J Med. 1982; 307: 1432-1435.

17. O’Brien J.M., Barton J.R. Controversies with the diagnosis and management of HELLP syndrome. Clin. Obstet. Gynec. 2005; 48 (2): 460-77.

18. Pourrat O., Coudroy R., Pierre F. ADAMTS13 deficiency in severe postpartum HELLP syndrome. Br J Haematol. 2013 Nov; 163 (3): 409-10.

19. Raife T., Montgomery R. New aspects in the pathogenesis and threatment of Thrombotic thrombocytopenic purpura and hemolytic uremic synfrome. Rev Clin Exp Hematol; 2001, 5 (3): 536-561.

20. Rock G.A., Shumak K.H., Buskard N.A. et al. Comparison of plasma exchange with plasma infusion in the treatment of thrombotic thrombocytopenic purpura. Canadian Apheresis Study Group. N Engl J Med. 1991 8; 325 (6): 393-7.

21. Ruggenenti P., Noris M., Remuzzi G. Thrombotic microangiopathy, hemolytic uremic syndrome, and thrombotic thrombocytopenic purpura. Kidney Int, 2001; 60 (3): 831-46.

22. Schaller M., Studt J.D., Voorberg J., Kremer Hovinga J.A. Acquired thrombotic thrombocytopenic purpura. Development of an autoimmune response. Hamostaseologie. 2013 May 29; 33 (2): 121-30.

23. Sibai B.M., Ramadan M.K., Usta I. et al. Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome). Amer. J. Obstet. Gynec. 1993; 169: 1000-6.

24. 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: 84-90.

For citation:

Akinshina S.V., Bitsadze V.O., Gadaeva Z.K., Makatsariya A.D. THROMBOTIC MICROANGIOPATHY IN THE PATHOGENESIS OF OBSTETRIC COMPLICATIONS. Obstetrics, Gynecology and Reproduction. 2015;9(2):62-71. (In Russ.) https://doi.org/10.17749/2070-4968.2015.9.2.062-71