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