Thrombotic microangiopathy and pregnancy

Česká verze

Authors: M. Koucký ¹; A. Toman ³; R. Ryšavá ²; A. Pařízek ¹
Authors place of work: Gynekologicko-porodnická klinika 1. LF UK a VFN, Praha, přednosta prof. MUDr. A. Martan, DrSc. ¹; Klinika nefrologie 1. LF UK a VFN, Praha, přednosta prof. MUDr. V. Tesař, MBA, DrSc. ²; Gynekologicko-porodnické oddělení Oblastní nemocnice, Kolín, primář MUDr. A. Toman, MBA ³
Published in the journal: Ceska Gynekol 2020; 85(1): 18-28
Category: Přehled a kazuistiky

Summary

Objective: The aim of this study is to draw attention to a nosological unit called thrombotic microangiopathy (TMA). This syndrome represents a serious pathological condition characterized by microangiopathic haemolytic anemia (MAHA), thrombocytopenia and various organ dysfunction. Patients are most often presented with symptoms of the HELLP syndrome but if the clinical picture is not restituted within 48–72 hours after delivery, other TMAs should be considered.

Setting: Department of Obstetrics and Gynecology, 1st Medical Faculty and General Teaching Hospital Prague; Clinic of Nephrology, 1st Medical Faculty and General Teaching Hospital Prague; Department of Obstetrics and Gynecology, Regional Hospital Kolín.

Design: Review article and case reports.

Methods: Review of the literature and description of two cases of TMA.

Conclusion: The authors present a basic overview of the issue of TMA, which requires interdisciplinary cooperation of obstetricians, anesthesiologists, nephrologists and hematologists. In the second part of the article, we present two TMA case reports and finally show the differential diagnostic and therapeutic scheme as agreed by the authorities in the field.

Keywords:

HELLP syndrome – eculizumab – thrombotic microangiopathy – atypical hemolytic uremic syndrome – hemolytic uremic syndrome – thrombotic thrombocytopenic purpura – acute fatty liver of pregnancy

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