Thrombocytopenia in pregnancy – pathogenesis and diagnostic approach

Jodkowska, Anna; Martynowicz, Helena; Kaczmarek-Wdowiak, Beata; Mazur, Grzegorz

doi:10.5604/17322693.1179649

Cited by 33 publications

(34 citation statements)

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“…Often a secondary result of endothelial dysfunction in PE is hyper coagulation due to release of thrombotic factors from damaged endothelial cells and increased leukocyte traffic to the injured tissue. We will not focus on thrombosis in PE in this review and instead refer to recent reviews in the area (Jodkowska et al 2015). Taken together, the indicators of endothelial dysfunction in PE often feed forward onto each other, exacerbating the condition.…”

Section: Preeclampsiamentioning

confidence: 99%

Vascular adaptation in pregnancy and endothelial dysfunction in preeclampsia

Boeldt

Bird

2017

Journal of Endocrinology

249

152

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Maternal vascular adaptation to pregnancy is critically important in order to expand the capacity for blood flow through the uteroplacental unit to meet the needs of the developing fetus. Failure of the maternal vasculature to properly adapt can result in hypertensive disorders of pregnancy such as preeclampsia (PE). Herein, we review the endocrinology of maternal adaptation to pregnancy and contrast this with that of PE. Our focus is specifically on those hormones with directly impact endothelial cell function and dysfunction, as endothelial cell dysfunction is a hallmark of PE. A variety of growth factors and cytokines are present in normal vascular adaptation to pregnancy but have also been shown to be circulating at abnormal levels in PE pregnancies. Many of these factors promote endothelial dysfunction when present at abnormal levels by acutely inhibiting key Ca2+ signaling events and chronically promoting the breakdown of endothelial cell-cell contacts. Increasingly, our understanding of how the contributions of the placenta, immune cells, and the endothelium itself promote the endocrine milieu of PE is becoming more clear. We then describe in detail how the complex endocrine environment of PE effects endothelial cell function, why this has contributed to the difficulty in fully understanding and treating this disorder, and how a focus on signaling convergence points of many hormones may be a more successful treatment strategy.

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Section: Preeclampsiamentioning

confidence: 99%

Vascular adaptation in pregnancy and endothelial dysfunction in preeclampsia

Boeldt

Bird

2017

Journal of Endocrinology

249

152

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“…Se ha demostrado que la elevación de las concentraciones de citoquinas pro-inflamatorias conduce a la producción de plaquetas de mayor tamaño que se agregan más rápidamente, tienen mayores niveles de tromboxano A2 y expresan más receptores de glicoproteína IIb/IIIa 16 . Estos hallazgos son reforzados por la evidencia de correlación entre hipertensión y cambios en la agregación plaquetaria [17][18][19] .…”

Section: Discussionunclassified

“…Durante el embarazo, el aumento de la agregación plaquetaria es compensado por aumento de la síntesis plaquetaria y del volumen plaquetario medio 14 . Se ha descrito en embarazos complicados con hipertensión activación plaquetaria intravascular, depósitos de fibrina y consumo de plaquetas sin control, lo que se traduce en un incremento del volumen plaquetario medio al final del embarazo 17,18 . Existe correlación significativa entre la hipertensión y los cambios en la agregación plaquetaria durante el embarazo [17][18][19] .…”

Section: Discussionunclassified

“…Se ha descrito en embarazos complicados con hipertensión activación plaquetaria intravascular, depósitos de fibrina y consumo de plaquetas sin control, lo que se traduce en un incremento del volumen plaquetario medio al final del embarazo 17,18 . Existe correlación significativa entre la hipertensión y los cambios en la agregación plaquetaria durante el embarazo [17][18][19] . El aumento en el tamaño de las plaquetas es más marcado en las preeclámpticas que en las embarazadas normotensas 15 .…”

Section: Discussionunclassified

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Utilidad diagnóstica del volumen plaquetario medio en embarazadas con preeclampsia

Rondón-Tapía

Mejia-Montilla

Reyna-Villasmil

et al. 2018

Rev. chil. obstet. ginecol.

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Utilidad diagnóstica del volumen plaquetario medio en embarazadas con preeclampsia. RESUMENOBJETIVO: Establecer la utilidad diagnóstica del volumen plaquetario medio en embarazadas con preeclampsia. MÉTODOS: Se realizó un estudio de de casos y controles en el Hospital Central "Dr. Urquinaona", Maracaibo, Venezuela. Se seleccionó un total de 180 embarazadas. Se incluyeron 90 preeclámpticas como grupo de estudio (grupo A) y un grupo de control seleccionado por tener edad e índice de masa corporal similares al grupo de estudio, que consistió en 90 embarazadas normotensas sanas (grupo B). Las muestras de sangre se recolectaron en todas las pacientes antes del parto e inmediatamente después del diagnóstico en el grupo A, para determinar los valores de volumen plaquetario medio. Se determinaron las características generales, valores de volumen plaquetario medio y eficacia diagnóstica. RESULTADOS: Se encontraron diferencias estadísticamente significativas en los valores de volumen plaquetario medio entre las pacientes del grupo A (10,35 +/-1,11 fL) y las pacientes del grupo B (9,54 +/-0,96 fL; p < 0,001). No se observaron correlaciones significativas con los valores de presión arterial sistólica y diastólica (p = ns). Un valor de corte de 10,3 fL presentó un valor por debajo de la curva de 0,71, sensibilidad del 53,3%, especificidad del 63,1%, valor predictivo positivo del 63,2% y valor predictivo negativo del 59,6%, con una exactitud diagnóstica del 61,1%. CONCLUSIÓN: Los valores volumen plaquetario medio no son útiles para discriminar el diagnóstico de preeclampsia en las embarazadas, a pesar que las preeclámpticas presentaron valores significativamente más elevados de al compararlo con embarazadas normotensas sanas.

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“…The Tenessee system proposed strict criteria for the complete syndrome -intravascular haemolysis diagnosed by abnormal peripheral blood smear, increased serum bilirubin more than 20.5 umol per L and elevated LDH levels more than 600 units per L. The Mississippi classification is the triple class system based on the nadir platelets count during the disease. Class I and II is associated with haemolysis (LDH more than 600 units per L) and elevated AST (more than 70 U/L), while class III requires only LDH levels more than 600 units per L and AST more than 40 in addition to the specifi c PLT count in the interval 100 to 150.10 9 per L (22,23).…”

Section: Diagnostic Criteriamentioning

confidence: 99%

Postpartum corticosteroids in HELLP syndrome – standard to prompt recovery

Gábor¹,

Drab²,

Holomán³

2016

BLL

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OBJECTIVES: To perform a complex review of HELLP syndrome and its treatment from up to date scientifi c literature. Study of the interresting treatement regime of the patient. METHODS: Complex analysis of the syndrome, systematic search of medical scientifi c databases and Slovak Medical Library. Analysis of the life threatening state of the patient, retrospective analysis of the diagnostics, treatment, acute management, complications and clinical results. RESULTS: According to up to date literature and our good clinical experiences we can encourage the use of high-dose corticosteroid therapy in HELLP syndrome. CONCLUSION: The most recent studies defi nitely recommend the high dose corticosteroid treatment in recovery management by the HELLP syndrome. We have used the high-dose corticosteroid regime as a recovery management for the patient with postpartum HELLP with very good clinical and laboratory response followed by prompt recovery of the patient and without other complications. We want to support and empasize the indication of the Dexamethasone regiment by HELLP, becouse the clinical experiences with this treatment are not well-known and usually the corticosteroids are not given to the patients with HELLP, or the treatment is "daemonized". Our clinical experience with this treatment was successful and the patient defi nitely profi ted of it. We support the opinion, that the benefi t of described regiment highly exceedes the possible adverse effects of the therapy (Fig. 8, Ref. 61). Text in PDF www.elis.sk.

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Thrombocytopenia in pregnancy – pathogenesis and diagnostic approach

Cited by 33 publications

References 0 publications

Vascular adaptation in pregnancy and endothelial dysfunction in preeclampsia

Vascular adaptation in pregnancy and endothelial dysfunction in preeclampsia

Utilidad diagnóstica del volumen plaquetario medio en embarazadas con preeclampsia

Postpartum corticosteroids in HELLP syndrome – standard to prompt recovery

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