Factors Related to Thrombotic Microangiopathies in Pregnancy: Integrative Review
DOI:
https://doi.org/10.3823/1745Keywords:
Pregnancy, Hematological Complications in Pregnancy, High-Risk Pregnancy, Risk Factors, Literature Review.Abstract
Introduction: Pregnancy is a state that can precipitate the occurrence of a thrombotic microangiopathy (TMA), characterized by the presence of microangiopathic hemolytic anemia and the existence of thrombi in the microcirculation. Conditions not very common, but that determine high maternal and fetal morbidity and mortality, as Hemolytic Uremic Syndrome (HUS), Thrombotic Thrombocytopenic Purpura (TTP) and Hemolysis Elevated Liver Enzymes, and Low Platelet Count
(HELLP) syndrome.
Objective: Identifying factors related to the occurrence of thrombotic microangiopathy in pregnancy, based on the analysis of scientific production.
Method: An integrative review of literature, using the descriptors thrombotic microangiopathy, pregnancy, thrombotic microangiopathy, pregnancy; the consulted databases were PubMed, LILACS and SciELowith six articles published between 2003 and August 2014. The results were shown in summary frames.
Results: Evidence points to the failure in the cleavage of multimers of von Willebrand factor (FvW), due to defiiency of plasma metalloprotease ADAMTS13 in TTP; endothelial activation as responsible for hemolytic thrombotic state, which occurs in the diathesis gravidarum HELLP syndrome and the alternative pathway of complement dysregulation involved in atypical aspect of the HUS are the main pathophysiological mechanisms involved in the TMA. But sometimes
the differentiation between these three microangiopathic syndromes is diffciult to perform, the remaining penumbra of intersectional or undifferentiated states; and often to supportive therapy more effective way of handling such disorders.
Conclusion: The spectrum of diseases that make up the thrombotic microangiopathy in pregnancy have multifactorial trait and much remains to be unveiled on its real pathophysiological mechanism, as well as the differentiating factors between the TMA in order to provide better clinical management in the future.
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