Thrombotic Microangiopathies of Pregnancy: Differential Diagnosis
Publication date: Available online 16 February 2018 Source:Pregnancy Hypertension Author(s): M. Gupta, B.B. Feinberg, R.M. Burwick Thrombotic microangiopathy (TMA) disorders are characterized by microangiopathic hemolytic anemia, thrombocytopenia and end-organ injury. In pregnancy and postpartum, TMA is most commonly encountered with HELLP (hemolysis, elevated liver enzymes, low platelet count syndrome) or preeclampsia with severe features, but rarely TMA is due to thrombotic thrombocytopenic purpura (TTP) or atypical hemolytic uremic syndrome (aHUS). Due to overlapping clinical and laboratory features, TTP and aHUS are often mistaken for preeclampsia or HELLP. Unfortunately, delays in appropriate diagnosis and treatment may be life-threatening. Our objective is to alert obstetrician-gynecologists, certified nurse midwives, family medicine providers, and subspecialty consultants, to the range of TMA disorders that may occur in and around pregnancy. To do this, we have provided a review of individual disorders that comprise the differential diagnosis of pregnancy TMA, and we have proposed a systematic approach to make an accurate diagnosis with readily available clinical and laboratory data. In complex or critical cases, we recommend a multidisciplinary team approach (e.g., Critical Care, Hematology, Maternal Fetal Medicine, Nephrology) to expedite diagnosis and treatment, which may be life-saving.
Publication date: October 2020Source: Biomedicine &Pharmacotherapy, Volume 130Author(s): Yafeng Wang, Delong Duo, Yingjun Yan, Rongyue He, Xinan Wu
CONCLUSIONS: This study demonstrates that TPPU effectively lowers L-NAME-induced hypertension in rats. The mechanism of its antihypertensive effect is likely mediated by the suppression of ACE gene and protein expression, leading to a lower Ang II level. PMID: 32767352 [PubMed - in process]
Authors: Dar SA, Wahid M, Haque S, Almalki SS, Akhter N PMID: 32767316 [PubMed - in process]
Complement-mediated thrombotic microangiopathy (TMA), also known as atypical hemolytic uremic syndrome (aHUS) is a rare, hereditary, progressive, life-threatening disorder caused by a disruption in regulation of the alternative pathway of the complement system. Eculizumab, a terminal complement inhibitor, has emerged as a first-line therapy, however data are limited to small case series (Brocklebank et al., 2017). Here, we present a diagnostically challenging case of complement-mediated TMA, who received eculizumab therapy with excellent hematologic response.A 68-year-old female with history of possible Sjogren's syndrome,...
Publication date: April 2018Source: Pregnancy Hypertension, Volume 12Author(s): M. Gupta, B.B. Feinberg, R.M. BurwickAbstractThrombotic microangiopathy (TMA) disorders are characterized by microangiopathic hemolytic anemia, thrombocytopenia and end-organ injury. In pregnancy and postpartum, TMA is most commonly encountered with HELLP (hemolysis, elevated liver enzymes, low platelet count syndrome) or preeclampsia with severe features, but rarely TMA is due to thrombotic thrombocytopenic purpura (TTP) or atypical hemolytic uremic syndrome (aHUS). Due to overlapping clinical and laboratory features, TTP and aHUS are often mi...
We present one case of HUS caused by adenovirus in a boy of 1 year and 7 months old with severe evolution, which required peritoneal dialysis.Diagnose:Stool sample repeated examination for adenovirus antigen was positive in 2 samples.Intervention:During hospitalization, the patient required 8 peritoneal dialysis sessions.Outcome:The renal function was corrected on discharge, the patient required cardiovascular monitoring 1 month after discharge.Lesson:Although the most common cause that leads to HUS remains STEC, other etiologies like viral ones that may be responsible for severe enteric infection with progression into HUS...
We describe how we use these criteria to evaluate and manage pregnant/postpartum women with MAHA and thrombocytopenia. PMID: 26637783 [PubMed - in process]
Conclusions We demonstrate that, even in patients with atypical hemolytic uremic syndrome and prolonged dialysis dependence, recovery of renal function can be seen with eculizumab treatment. We suggest a treatment regime of at least three months prior to evaluation of efficacy.
This article aims to review the main diseases included in the differential diagnosis of CAPS in the context of other thrombotic microangiopathies.