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Research Article Volume 11 Issue 1
LDH/AST ratio: a futureresourcefor thrombotic microangiopathies differential diagnosis in pregnancy
Mei Federica, Falchi Nadia, Tamaraschi Denise, Bottone Pietro, Bertolotto Alessandra, Bianchi Cristina, Trojano Giuseppe, Simoncini Tommaso, Battini Lorella
Fetal Maternal Department, Pisa University, Healthcare System, First Unit, AOUP, Italy
Fetal Maternal Department, Pisa University, Healthcare System, Second Unit, AOUP, Italy
Endocrinology and Metabolism Department, Pisa University, Healthcare System, AOUP, Italy
Received: January 14, 2020 | Published: February 6, 2020
Citation: Federica M, Nadia F, Denise T, et al. LDH/AST ratio: a future resource for thrombotic microangiopathies differential diagnosis in pregnancy. Obstet Gynecol Int J. 2020;11(1):44-48. DOI: 10.15406/ogij.2020.11.0487
Abstract
Objective: Toevaluate the clinical approach, the diagnostic method and the most appropriate therapeutic management of thrombotic microangiopathies (TMA) in pregnancy, still leading killers in the obstetric area today.
Materials and methods: A large review of the international literature and available clinical studies has been carried out in order to define the current state of the art regarding TMA in pregnancy. In the light of this, 9 clinical cases, among 152 TMA cases, of pregnant women hospitalized and who gave birth in the Pisa University Hospital O.O. U.U. Gynecology and Obstetrics 1 and 2 from 2010 to 2019, were identified, analyzed and re-discussed.
Results: Analyzing the diagnostic method and the medical records, we made a critical review of these 9 cases, accurately analyzing the diagnoses made. Among these cases, 6 Thrombotic Thrombocytopenic Purpura (TTP), 2 HELLP Syndrome and 1 Atypical Hemolytic Uremic Syndrome (aHUS) were diagnosed during pregnancy. By analyzing the medical records, the diagnostic method and thetherapeuticmanagement of these patients, we questioned the diagnoses made. These diagnoses, from our analytical point of view, are partially not corresponding, being 4 cases of TTP and 5 possible cases of aHUS.
Conclusion: From the review of our case history, in the Pisa Obstetric clinics, it is possible to find an under diagnosis of the aHUS cases compared to those of TTP and HELLP syndrome, due both to the unavailability of the ADAMTS13 functionality test and to the unused LDH/AST ratio, which in our opinion could represent a future resource in diagnostic approach to thrombotic microangiopathies in pregnancy.
Keywords: Thrombotic microangiopathies, Pregnancy, HELLP syndrome, Thrombotic thrombocytopenic purpura, Atypical hemolytic-uremic syndrome, Disseminated intravasal coagulation, Thrombocytopenia, Hemolytic anemia, Willebrand factor, Malignant hypertension, Bone marrow, Systemic lupus erythematosus, Tumors
©2020 Federica, et al. This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and build upon your work non-commercially.