Anatol J Med . 1995; 5(1): 5-10 | DOI: 10.5222/terh.1995.24983

Thrombotic Microangiopathies in Pregnancy And The Postpartum Period

Şinasi Salman¹
9 Eylül University of Medical Schooll, Fellow and lnstructor in Nephrology, Izmir Turkey

Detecion of trombocytopenia and hemolytic anemia during pregnancy and the postpartum period alarms the physician becaus these are recognized as the signs of severe potentially life threatening syndromes such as pregnancy associated thrombotic thrombocytopenic purpura (TTP), hemolysis-elevated liver enzymes-low platet count (HELLP) syndrome, and postpartum hemolytic uremic syndrome (PHUS). Subsequent to different initial insults the final pathologic processes produce similar clinacal pictures, and although their treatments differ considerably many times differential diagnosis of these three clinical syndromes is impossible before starting empiric treatment. Plasmapheresis with plasma exchange is the treatment of choice for TTP and PHUS whereas delivery is indicated for HELLP syndrome. Once recognized patients with thrombotic microangiopathies should be transferred to tertiary care hospitals where the mother and infant can get adequate treatment.

Keywords: HELLP Syndrome, Hemolytic Uremic Syndrome, Thrombocytopenic Purpura

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Gebelik ve Lohusaliktaki Trombotik Mikroanjiyopatiler

Şinasi Salman¹
9 Eylül University of Medical Schooll, Fellow and lnstructor in Nephrology, Izmir Turkey

Gebelik ve lohusalık döneminde trombositopeni ve hemolitik aneminin saptanması hekimleri tedirgin eder, çünkü bu bulgular trombotik trombositopenik purpura (TTP), hemoliz, yüksek hepatik enzimler, düşük trombosit sayısı (HELLP) sendromu ve postpartum-lohusalık hemolitik uremik sendromu (PHUS) gibi hayatı tehdit edici birkaç sendromun belirtileridirler. Patogenezde değişik olaylar yer alsa da sonuçta bu sendromlarda birbirine benzer klinik tablolar ortaya çıkar ve çoğu kez ampirik tedavi başlamadan ayırıcı tam yapmak imkansız gibidir. Plasma değişimli plasmaferez TTP ve PHUS tedavisinde gerekli iken HELLP sendromunda gebeliğin sonlandırılması gereklidir. Farkedildikleri takdirde thrombotik miroanjiopatili gebeler ve lohusalar tam teşekküllü hastanelere sevk edilmelidirler.

Anahtar Kelimeler: HELLP Sendromu, Hemolitik Üremik Sendrom, Thrombotik Thrombositopenik Purpura

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