Thrombotic microangiopathy during pregnancy

Microvasc Res. 2021 Nov:138:104226. doi: 10.1016/j.mvr.2021.104226. Epub 2021 Jul 9.


Pregnancy is a high-risk time for the development of different kinds of thrombotic microangiopathy (TMA). Three major syndromes including TTP (thrombotic thrombocytopenic purpura), PE/HELLP (preeclampsia/hemolysis, elevated liver function tests, low platelets), and aHUS (atypical hemolytic- uremic syndrome) should be sought in pregnancy-TMA. These severe disorders share multiple clinical features and overlaps and even the coexistence of more than one pathologic mechanism. Each of these disorders finally ends in endothelial damage and fibrin thrombi formation within the microcirculation that fragments RBCs (schystocytes), aggregates platelets, and creates ischemic injury in the targeted organs i.e.; kidney and brain. Although the mechanisms of these severe disorders have been revealed, pregnancy-related TMA still interfaces with diagnostic and therapeutic challenges. Here, we highlight the current knowledge of diagnosis and management of these complications during pregnancy.

Keywords: Atypical hemolytic uremic syndrome; Microangiopathy; Pre-eclampsia; Pregnancy; Purpura, thrombotic thrombocytopenic.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Animals
  • Atypical Hemolytic Uremic Syndrome / blood
  • Atypical Hemolytic Uremic Syndrome / diagnosis
  • Atypical Hemolytic Uremic Syndrome / physiopathology*
  • Atypical Hemolytic Uremic Syndrome / therapy
  • Diagnosis, Differential
  • Female
  • HELLP Syndrome / blood
  • HELLP Syndrome / diagnosis
  • HELLP Syndrome / physiopathology*
  • HELLP Syndrome / therapy
  • Humans
  • Pre-Eclampsia / blood
  • Pre-Eclampsia / diagnosis
  • Pre-Eclampsia / physiopathology*
  • Pre-Eclampsia / therapy
  • Predictive Value of Tests
  • Pregnancy
  • Prognosis
  • Purpura, Thrombotic Thrombocytopenic / blood
  • Purpura, Thrombotic Thrombocytopenic / diagnosis
  • Purpura, Thrombotic Thrombocytopenic / physiopathology*
  • Purpura, Thrombotic Thrombocytopenic / therapy