Coagulation/Fibrinolysis and laboratory characteristics of pregnant women with severely depressed antithrombin activity

Yamada, Takashi; Ishikawa, Satoshi; Kataoka, Soromon; Uda, Tomohiro; Iinuma, Youichiro; Hattori, Rifumi; Yamada, Takahiro; Morikawa, Mamoru; Kaneuchi, Masanori; Minakami, Hisanori

doi:10.3109/10641955.2013.792346

Cited by 14 publications

(21 citation statements)

References 15 publications

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“…In the present patient, fibrinogen level decreased and d ‐dimer level increased with decreasing AT activity (Figs ), confirming results of a previous study . This suggested the following events in this patient: AT was consumed by exaggerated thrombin generation, perhaps via vascular endothelial cell dysfunction; thrombin facilitated consumption of fibrinogen, and fibrinolysis caused the increase in d ‐dimer.…”

Section: Discussionsupporting

confidence: 90%

“…Given that women with hypertensive disorders of pregnancy (HDP) are likely to develop HELLP syndrome, laboratory work‐up including blood variables, such as platelet count, AST, and LDH, is recommended in such cases . Some patients with elevated AST and LDH, however, lack low platelet count in the presence of severely depressed anti‐thrombin (AT, also termed AT III) activity level, designated as pregnancy‐induced AT deficiency (PIATD), which can precede the clinical manifestation of acute fatty liver of pregnancy (AFLP) …”

Section: Introductionmentioning

confidence: 99%

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Isolated pregnancy‐induced anti‐thrombin deficiency in a woman with twin pregnancy

Kawabata

Morikawa

Yamada

et al. 2016

J of Obstet and Gynaecol

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A woman with twin pregnancy had a gradual decline in anti-thrombin (AT) activity from 72% at gestational week (GW) 29 , to 53% at GW31 , and to 41% at GW32 , at which time hypertension (148/90 mmHg) and proteinuria (protein-to-creatinine ratio [P/Cr], 0.79 mg/mg) developed in the presence of normal platelet count (159 × 10 /L) and serum aspartate aminotransferase/lactate dehydrogenase (22/164 IU/L). AT product was given three times to maintain AT activity >50% and blood pressure was maintained below 155/95 mmHg with no treatment, but generalized edema with a weekly weight gain of 4.9 kg and increased proteinuria (to P/Cr, 7.6 mg/mg) required cesarean section at GW33 . This case highlights the occurrence of pregnancy-induced AT deficiency alone in the absence of any other abnormality, including hypertension, proteinuria, or thrombocytopenia. Measurement of AT activity was considered helpful for determination of the appropriate time for delivery in this patient.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Isolated pregnancy‐induced anti‐thrombin deficiency in a woman with twin pregnancy

Kawabata

Morikawa

Yamada

et al. 2016

J of Obstet and Gynaecol

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“…As the Swansea criteria used in the previous studies do not incorporate status of AT activity, AFLP may have been diagnosed after clinical symptoms of AFLP appeared. However, such clinical symptoms as vomiting, abdominal pain, polydipsia/polyuria and encephalopathy appear not to manifest until women show profoundly depressed AT activity <45% …”

Section: Discussionmentioning

confidence: 99%

Liver dysfunction in triplet pregnancies: Relation to antenatal changes in antithrombin activity and platelet count

Nishida

Morikawa

Yamada

et al. 2014

J of Obstet and Gynaecol

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“…In addition to thrombocytopenia, our patient had significantly reduced antithrombin III levels (approximately 20% below the normal limit). The hypercoagulable state arising from the markedly reduced levels of antithrombin III, due to inability of the liver to produce the protein, may contribute to the development of pituitary apoplexy (17). In summary, peripartum fluctuations in blood pressure, acute blood loss, acute stress, and coagulopathy secondary to acute liver failure may have all contributed to an increased risk of pituitary apoplexy in an already enlarged gland.…”

Section: Discussionmentioning

confidence: 99%

Concomitant Pituitary Apoplexy and Acute Fatty Liver of Pregnancy Complicated With Disseminated Intravascular Coagulation

Barvalia

Eliades

Melhem

2015

AACE Clinical Case Reports

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Objective: Pituitary complications during delivery are relatively rare in developed countries. In this case report we describe a case of panhypopituitarism during pregnancy with concomitant acute liver failure.Methods: We present the case of a pregnant female with acute fatty liver of pregnancy (AFLP) complicated by panhypopituitarism. We also review the current literature on cases of anterior pituitary hormone deficiencies with AFLP, including presentation, management, and outcomes.Results: A 29 year-old female at 25-weeks gestation presented with subacute onset of headache accompanied by nausea and vomiting. She was diagnosed with acute liver failure and coagulopathy secondary to disseminated intravascular coagulation (DIC). Further workup revealed deficiencies of all anterior pituitary hormones, and magnetic resonance imaging (MRI) of the brain was compatible with pituitary hemorrhage/apoplexy from probable infarction.Conclusion: AFLP, especially in association with DIC, can lead to pituitary apoplexy and panhypopituitarism related to underlying coagulopathy. Given the high mortality rates associated with pituitary apoplexy, clinical awareness and a high index of suspicion are important for diagnosing this condition. Prompt initiation of hormone replacement therapy is essential to reduce morbidity and mortality risk. CASE REPORTA 29-year-old Caucasian female who had previously given birth to 4 children presented at 25-weeks gestation to a hospital external to our health care system with a 1-week history of bifrontal headache and profound fatigue, which she described as flu-like symptoms. She had associated persistent nausea and vomiting every other day but was able to carry out her daily activities and go to work. She reported the headaches being distinctly different from migraine episodes that she recalled as last occurring 1 year prior to her current presentation. Fatigue and generalized weakness accompanied her headaches, but she denied having hematemesis, abdominal pain, or bloating. Her headaches persisted despite using over-the-counter medications including acetaminophen, 1,000 mg, every 8 hours. During the next week she noticed reduced frequency of fetal movements, which prompted her to seek medical care at a nearby hospital. At that visit, the patient was noted to be confused, tachycardic, and jaundiced. Her laboratory workup was significant for hypoglycemia with blood glucose of 40 mg/dL (reference range 70-99) and elevated creatinine at 2.82 mg/dL (reference range 0.6-1.35). Her liver function tests were abnormal, including elevated aspartate aminotransferase (AST) at 205 U/L (reference range 10-40), alanine amino transferase (ALT) at 224 IU/L (reference range 9-46), alkaline phosphatase at 215 IU/L (reference range 40-115), and total bilirubin at 11.9

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Coagulation/Fibrinolysis and laboratory characteristics of pregnant women with severely depressed antithrombin activity

Cited by 14 publications

References 15 publications

Isolated pregnancy‐induced anti‐thrombin deficiency in a woman with twin pregnancy

Isolated pregnancy‐induced anti‐thrombin deficiency in a woman with twin pregnancy

Liver dysfunction in triplet pregnancies: Relation to antenatal changes in antithrombin activity and platelet count

Concomitant Pituitary Apoplexy and Acute Fatty Liver of Pregnancy Complicated With Disseminated Intravascular Coagulation

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