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.Bitsadze V.O., Khizroeva D.Kh., Makatsaria A.D., Stulyova N.S., Akinshina S.V.
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 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.
Keywords
thrombotic microangiopathy
ADAMTS-13
preeclampsia
fetal loss syndrome
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Received 03.11.2016
Accepted 11.11.2016
About the Authors
Alexander Makatsariya, MD, PhD Professor, Correspondent Member of the Russian Academy of Sciences, Head of the Chair of Obstetrics and Gynecology of Medical Prophylaxis Faculty of I.M. Sechenov First Moscow State Medical University, Vice-President of Russian Association of Obstetricians and Gynaecologists.109004, Russia, Moscow, Zemlyanoi Val, 62. Tel.: +79037280897. E-mail: gemostasis@mail.ru
Viktoriya Bitsadze, MD, PhD, Professor of the Chair of Obstetrics and Gynecology of Medical Prophylaxis Faculty of I.M. Sechenov First Moscow State Medical University. 109004, Russia, Moscow, Zemlyanoi Val, 62. Tel.: +79262313829. E-mail: vikabits@mail.ru
Jamilya Khizroeva, MD, PhD, assistant of the Chair of Obstetrics and Gynecology of Medical Prophylaxis Faculty of I.M. Sechenov First Moscow State Medical University. 109004, Russia, Moscow, Zemlyanoi Val, 62. Tel.: +79153619073. E-mail: totu1@yandex
Stuleva Nadezhda Sergeevna, PhD, vice-principal of the Department “Clinical hemostasis” of I.M. Sechenov First Moscow State Medical University.
109004, Russia, Moscow, Zemlyanoi Val, 62. Tel.: +79262339619. E-mail: stulevans@mail.ru.
Svetlana Akinshina, MD, PhD, assistant of the Chair of Obstetrics and Gynecology of Medical Prophylaxis Faculty of I.M. Sechenov First Moscow State Medical University. 109004, Russia, Moscow, Zemlyanoi Val, 62. Tel.: +79032388048. E-mail: gemostasis@mail.ru
For citations: Bitsadze V.O., Khizroeva D.Kh., Makatsaria A.D., Stulyova N.S., Akinshina S.V. 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. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2017; (5): 138-43. (in Russian)
http://dx.doi.org/10.18565/aig.2017.5.138-43
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