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Thrombotic Microangiopathies in Pregnancy

  • Chapter
Disorders of Thrombosis and Hemostasis in Pregnancy

Abstract

Thrombotic microangiopathies (TMAs) describe a collection of disorders with similar presenting features but different underlying pathogenesis and often differing therapies. TMAs are defined by the presence of thrombocytopenia, hemolytic anemia and fragmented red blood cells on a blood film, which is due to shearing of red blood cells caused by the presence of microthrombi. TMAs can present during or unrelated to pregnancy, and in pregnancy it can be difficult in the acute situation to confirm the underlying diagnosis. This chapter focuses on the diagnosis, pathophysiology and management of TMAs that are primarily precipitated by pregnancy.

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References

  1. Provan D, Stasi R, Newland AC, et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood. 2010;115:168–86.

    Article  CAS  PubMed  Google Scholar 

  2. Gernsheimer T, James AH, Stasi R. How I treat thrombocytopenia in pregnancy. Blood. 2013;121:38–47.

    Article  CAS  PubMed  Google Scholar 

  3. Cines DB, Blanchette VS. Immune thrombocytopenic purpura. N Engl J Med. 2002;346:995–1008.

    Article  PubMed  Google Scholar 

  4. Sibai B, Dekker G, Kupferminc M. Pre-eclampsia. Lancet. 2005;365:785–99.

    Article  PubMed  Google Scholar 

  5. Naljayan MV, Karumanchi SA. New developments in the pathogenesis of preeclampsia. Adv Chronic Kidney Dis. 2013;20:265–70.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Staff AC, Benton SJ, von Dadelszen DP, et al. Redefining preeclampsia using placenta-derived biomarkers. Hypertension. 2013;61:932–42.

    Article  CAS  PubMed  Google Scholar 

  7. Maynard SE, Venkatesha S, Thadhani R, Karumanchi SA. Soluble Fms-like tyrosine kinase 1 and endothelial dysfunction in the pathogenesis of preeclampsia. Pediatr Res. 2005;57:1R–7.

    Article  PubMed  Google Scholar 

  8. Yang JC, Haworth L, Sherry RM, et al. A randomized trial of bevacizumab, an anti-vascular endothelial growth factor antibody, for metastatic renal cancer. N Engl J Med. 2003;349:427–34.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  9. Chen CW, Jaffe IZ, Karumanchi SA. Pre-eclampsia and cardiovascular disease. Cardiovasc Res. 2014;101(4):579–86.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Smith GC, Pell JP, Walsh D. Pregnancy complications and maternal risk of ischaemic heart disease: a retrospective cohort study of 129,290 births. Lancet. 2001;357:2002–6.

    Article  CAS  PubMed  Google Scholar 

  11. Nicolaides KH, Bindra R, Turan OM, et al. A novel approach to first-trimester screening for early pre-eclampsia combining serum PP-13 and Doppler ultrasound. Ultrasound Obstet Gynecol. 2006;27:13–7.

    Article  CAS  PubMed  Google Scholar 

  12. Venkatesha S, Toporsian M, Lam C, et al. Soluble endoglin contributes to the pathogenesis of preeclampsia. Nat Med. 2006;12:642–9.

    Article  CAS  PubMed  Google Scholar 

  13. Levine RJ, Lam C, Qian C, et al. Soluble endoglin and other circulating antiangiogenic factors in preeclampsia. N Engl J Med. 2006;355:992–1005.

    Article  CAS  PubMed  Google Scholar 

  14. Steegers EA, von Dadelszen P, Duvekot JJ, Pijnenborg R. Pre-eclampsia. Lancet. 2010;376:631–44.

    Article  PubMed  Google Scholar 

  15. CLASP (Collaborative Low-dose Aspirin Study in Pregnancy) Collaborative Group. CLASP: a randomised trial of low-dose aspirin for the prevention and treatment of pre-eclampsia among 9364 pregnant women. Lancet. 1994;343:619–29.

    Article  Google Scholar 

  16. Golding J. A randomised trial of low dose aspirin for primiparae in pregnancy. The Jamaica Low Dose Aspirin Study Group. Br J Obstet Gynaecol. 1998;105:293–9.

    Article  CAS  PubMed  Google Scholar 

  17. Askie LM, Duley L, Henderson-Smart DJ, Stewart LA. Antiplatelet agents for prevention of pre-eclampsia: a meta-analysis of individual patient data. Lancet. 2007;369:1791–8.

    Article  CAS  PubMed  Google Scholar 

  18. Villa PM, Kajantie E, Raikkonen K, et al. Aspirin in the prevention of pre-eclampsia in high-risk women: a randomised placebo-controlled PREDO Trial and a meta-analysis of randomised trials. BJOG. 2013;120:64–74.

    Article  CAS  PubMed  Google Scholar 

  19. Kleinrouweler CE, van Uitert M, Moerland PD, et al. Differentially expressed genes in the pre-eclamptic placenta: a systematic review and meta-analysis. PLoS One. 2013;8:e68991.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  20. Gilbert JS, Verzwyvelt J, Colson D, et al. Recombinant vascular endothelial growth factor 121 infusion lowers blood pressure and improves renal function in rats with placentalischemia-induced hypertension. Hypertension. 2010;55:380–5.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. Hagmann H, Bossung V, Belaidi AA, et al. Low-Molecular Weight Heparin Increases Circulating sFlt-1 Levels and Enhances Urinary Elimination. PLoS One. 2014;9:e85258.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Rodger MA, Carrier M, Le GG, et al. Meta-analysis of low-molecular-weight heparin to prevent recurrent placenta-mediated pregnancy complications. Blood. 2014;123:822–8.

    Article  CAS  PubMed  Google Scholar 

  23. Kumasawa K, Ikawa M, Kidoya H, et al. Pravastatin induces placental growth factor (PGF) and ameliorates preeclampsia in a mouse model. Proc Natl Acad Sci U S A. 2011;108:1451–5.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  24. Witlin AG, Saade GR, Mattar F, Sibai BM. Predictors of neonatal outcome in women with severe preeclampsia or eclampsia between 24 and 33 weeks’ gestation. Am J Obstet Gynecol. 2000;182:607–11.

    Article  CAS  PubMed  Google Scholar 

  25. Sergio F, Maria CD, Gabriella F, et al. Prophylaxis of recurrent preeclampsia: low-molecular-weight heparin plus low-dose aspirin versus low-dose aspirin alone. Hypertens Pregnancy. 2006;25:115–27.

    Article  PubMed  Google Scholar 

  26. Funai EF, Friedlander Y, Paltiel O, et al. Long-term mortality after preeclampsia. Epidemiology. 2005;16:206–15.

    Article  PubMed  Google Scholar 

  27. Brown MC, Best KE, Pearce MS, Waugh J, Robson SC. Bell R Cardiovascular disease risk in women with pre-eclampsia: systematic review and meta-analysis. Eur J Epidemiol. 2013;28(1):1–19.

    Article  PubMed  Google Scholar 

  28. Ray JG, Vermeulen MJ, Schull MJ, Redelmeier DA. Cardiovascular health after maternal placental syndromes (CHAMPS): population-based retrospective cohort study. Lancet. 2005;366:1797–803.

    Article  PubMed  Google Scholar 

  29. Scully M, Hunt BJ, Benjamin S, et al. Guidelines on the diagnosis and management of thrombotic thrombocytopenic purpura and other thrombotic microangiopathies. Br J Haematol. 2012;158:323–35.

    Article  PubMed  Google Scholar 

  30. Moake JL, Rudy CK, Troll JH, et al. Unusually large plasma factor VIII: von Willebrand factor multimers in chronic relapsing thrombotic thrombocytopenic purpura. N Engl J Med. 1982;307:1432–5.

    Article  CAS  PubMed  Google Scholar 

  31. Fujikawa K, Suzuki H, McMullen B, Chung D. Purification of human von Willebrand factor-cleaving protease and its identification as a new member of the metalloproteinase family. Blood. 2001;98:1662–6.

    Article  CAS  PubMed  Google Scholar 

  32. Levy GG, Nichols WC, Lian EC, et al. Mutations in a member of the ADAMTS gene family cause thrombotic thrombocytopenic purpura. Nature. 2001;413:488–94.

    Article  CAS  PubMed  Google Scholar 

  33. Bell WR, Braine HG, Ness PM, Kickler TS. Improved survival in thrombotic thrombocytopenic purpura-hemolytic uremic syndrome. Clinical experience in 108 patients. N Engl J Med. 1991;325:398–403.

    Article  CAS  PubMed  Google Scholar 

  34. Scully M, Yarranton H, Liesner R, et al. Regional UK TTP registry: correlation with laboratory ADAMTS 13 analysis and clinical features. Br J Haematol. 2008;142:819–26.

    Article  PubMed  Google Scholar 

  35. Mannucci PM, Canciani MT, Forza I, et al. Changes in health and disease of the metalloprotease that cleaves von Willebrand factor. Blood. 2001;98:2730–5.

    Article  CAS  PubMed  Google Scholar 

  36. Sanchez-Luceros A, Farias CE, Amaral MM, et al. von Willebrand factor-cleaving protease (ADAMTS13) activity in normal non-pregnant women, pregnant and post-delivery women. Thromb Haemost. 2004;92:1320–6.

    CAS  PubMed  Google Scholar 

  37. Fujimura Y, Matsumoto M, Kokame K, et al. Pregnancy-induced thrombocytopenia and TTP, and the risk of fetal death, in Upshaw-Schulman syndrome: a series of 15 pregnancies in 9 genotyped patients. Br J Haematol. 2009;144(5):742–54.

    Article  CAS  PubMed  Google Scholar 

  38. Moatti-Cohen M, Garrec C, Wolf M, et al. Unexpected frequency of Upshaw-Schulman syndrome in pregnancy-onset thrombotic thrombocytopenic purpura. Blood. 2012;119:5888–97.

    Article  CAS  PubMed  Google Scholar 

  39. Ambrose A, Welham RT, Cefalo RC. Thrombotic thrombocytopenic purpura in early pregnancy. Obstet Gynecol. 1985;66:267–72.

    CAS  PubMed  Google Scholar 

  40. Rozdzinski E, Hertenstein B, Schmeiser T, et al. Thrombotic thrombocytopenic purpura in early pregnancy with maternal and fetal survival. Ann Hematol. 1992;64:245–8.

    Article  CAS  PubMed  Google Scholar 

  41. Scully M, Starke R, Lee R, Mackie I, Machin S, Cohen H. Successful management of pregnancy in women with a history of thrombotic thrombocytopaenic purpura. Blood Coagul Fibrinolysis. 2006;17:459–63.

    Article  PubMed  Google Scholar 

  42. Scully M, Thomas M, Underwood M, Watson H, Langley K, Camilleri RS, et al.; Collaborators of the UK TTP Registry. Thrombotic thrombocytopenic purpura and pregnancy: presentation, management, and subsequent pregnancy outcomes. Blood. 2014;124(2):211–9.

    Google Scholar 

  43. Lattuada A, Rossi E, Calzarossa C, Candolfi R, Mannucci PM. Mild to moderate reduction of a von Willebrand factor cleaving protease (ADAMTS-13) in pregnant women with HELLP microangiopathic syndrome. Haematologica. 2003;88:1029–34.

    CAS  PubMed  Google Scholar 

  44. Furlan M, Robles R, Morselli B, Sandoz P, Lammle B. Recovery and half-life of von Willebrand factor-cleaving protease after plasma therapy in patients with thrombotic thrombocytopenic purpura. Thromb Haemost. 1999;81:8–13.

    CAS  PubMed  Google Scholar 

  45. Ducloy-Bouthors AS, Caron C, Subtil D, et al. Thrombotic thrombocytopenic purpura: medical and biological monitoring of six pregnancies. Eur J Obstet Gynecol Reprod Biol. 2003;111:146–52.

    Article  PubMed  Google Scholar 

  46. Gris JC, Mercier E, Quere I, et al. Low-molecular-weight heparin versus low-dose aspirin in women with one fetal loss and a constitutional thrombophilic disorder. Blood. 2004;103:3695–9.

    Article  CAS  PubMed  Google Scholar 

  47. Dann AT, Kenyon AP, Seed PT, et al. Glutathione S-transferase and liver function in intrahepatic cholestasis of pregnancy and pruritus gravidarum. Hepatology. 2004;40:1406–14.

    Article  CAS  PubMed  Google Scholar 

  48. Riely CA. Acute fatty liver of pregnancy. Semin Liver Dis. 1987;7:47–54.

    Article  CAS  PubMed  Google Scholar 

  49. Uchida Y, Izai K, Orii T, Hashimoto T. Novel fatty acid beta-oxidation enzymes in rat liver mitochondria. II. Purification and properties of enoyl-coenzyme A (CoA) hydratase/3-hydroxyacyl-CoA dehydrogenase/3-ketoacyl-CoA thiolase trifunctional protein. J Biol Chem. 1992;267:1034–41.

    CAS  PubMed  Google Scholar 

  50. Jackson S, Kler RS, Bartlett K, et al. Combined enzyme defect of mitochondrial fatty acid oxidation. J Clin Invest. 1992;90:1219–25.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  51. Yang Z, Yamada J, Zhao Y, Strauss AW, Ibdah JA. Prospective screening for pediatric mitochondrial trifunctional protein defects in pregnancies complicated by liver disease. JAMA. 2002;288:2163–6.

    Article  PubMed  Google Scholar 

  52. Rath W, Faridi A, Dudenhausen JW. HELLP syndrome. J Perinat Med. 2000;28:249–60.

    Article  CAS  PubMed  Google Scholar 

  53. Martin Jr JN, Blake PG, Perry Jr KG, et al. The natural history of HELLP syndrome: patterns of disease progression and regression. Am J Obstet Gynecol. 1991;164:1500–9.

    Article  PubMed  Google Scholar 

  54. Barton JR, Sibai BM. Diagnosis and management of hemolysis, elevated liver enzymes, and low platelets syndrome. Clin Perinatol. 2004;31:807–33.

    Article  PubMed  Google Scholar 

  55. Sibai BM, Ramadan MK, Chari RS, Friedman SA. Pregnancies complicated by HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets): subsequent pregnancy outcome and long-term prognosis. Am J Obstet Gynecol. 1995;172:125–9.

    Article  CAS  PubMed  Google Scholar 

  56. Runnard Heimel PJ, Huisjes AJ, Franx A, et al. A randomised placebo-controlled trial of prolonged prednisolone administration to patients with HELLP syndrome remote from term. Eur J Obstet Gynecol Reprod Biol. 2006;128:187–93.

    Article  PubMed  Google Scholar 

  57. Fonseca JE, Mendez F, Catano C, Arias F. Dexamethasone treatment does not improve the outcome of women with HELLP syndrome: a double-blind, placebo-controlled, randomized clinical trial. Am J Obstet Gynecol. 2005;193:1591–8.

    Article  CAS  PubMed  Google Scholar 

  58. Woudstra DM, Chandra S, Hofmeyr GJ, Dowswell T. Corticosteroids for HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome in pregnancy. Cochrane Database Syst Rev. 2010;(9):CD008148.

    Google Scholar 

  59. Roberts WE, Perry Jr KG, Woods JB, et al. The intrapartum platelet count in patients with HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome: is it predictive of later hemorrhagic complications? Am J Obstet Gynecol. 1994;171:799–804.

    Article  CAS  PubMed  Google Scholar 

  60. Hofer J, Giner T, Józsi M. Complement factor h-antibody-associated hemolytic uremic syndrome: pathogenesis, clinical presentation, and treatment. Semin Thromb Hemost. 2014;40(4):r431–43.

    Article  Google Scholar 

  61. Salmon JE, Heuser C, Triebwasser M, Liszewski MK, Kavanagh D, Roumenina L, et al. Mutations in complement regulatory proteins predispose to preeclampsia: a genetic analysis of the PROMISSE cohort. PLoS Med. 2011;8(3):e1001013. doi:10.1371/journal.pmed.1001013.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  62. Fremeaux-Bacchi V, Fakhouri F, Roumenina L, Dragon-Durey MA, Loirat C. Atypical hemolytic-uremic syndrome related to abnormalities within the complement system. Rev Med Interne. 2011;32:232–40.

    Article  CAS  PubMed  Google Scholar 

  63. Fang CJ, Richards A, Liszewski MK, Kavanagh D, Atkinson JP. Advances in understanding of pathogenesis of aHUS and HELLP. Br J Haematol. 2008;143:336–48.

    Article  CAS  PubMed  Google Scholar 

  64. Cortes-Hernandez J, Ordi-Ros J, Paredes F, et al. Clinical predictors of fetal and maternal outcome in systemic lupus erythematosus: a prospective study of 103 pregnancies. Rheumatology (Oxford). 2002;41:643–50.

    Article  CAS  Google Scholar 

  65. Tincani A, Bompane D, Danieli E, Doria A. Pregnancy, lupus and antiphospholipid syndrome (Hughes syndrome). Lupus. 2006;15:156–60.

    Article  CAS  PubMed  Google Scholar 

  66. Levine JS, Branch DW, Rauch J. The antiphospholipid syndrome. N Engl J Med. 2002;346:752–63.

    Article  CAS  PubMed  Google Scholar 

  67. Chakravarty EF, Colon I, Langen ES, et al. Factors that predict prematurity and preeclampsia in pregnancies that are complicated by systemic lupus erythematosus. Am J Obstet Gynecol. 2005;192:1897–904.

    Article  PubMed  Google Scholar 

  68. Mak A, Cheung MW, Cheak AA, Ho RC. Combination of heparin and aspirin is superior to aspirin alone in enhancing live births in patients with recurrent pregnancy loss and positive anti-phospholipid antibodies: a meta-analysis of randomized controlled trials and meta-regression. Rheumatology (Oxford). 2010;49(2):281–8.

    Article  CAS  Google Scholar 

  69. Rai R, Cohen H, Dave M, Regan L. Randomised controlled trial of aspirin and aspirin plus heparin in pregnant women with recurrent miscarriage associated with phospholipid antibodies (or antiphospholipid antibodies). BMJ. 1997;314(7076):253–7.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  70. Goel N, Tuli A, Choudhry R. The role of aspirin versus aspirin and heparin in cases of recurrent abortions with raised anticardiolipin antibodies. Med Sci Monit. 2006;12:CR132–6.

    CAS  PubMed  Google Scholar 

  71. Farquharson RG, Quenby S, Greaves M. Antiphospholipid syndrome in pregnancy: a randomized, controlled trial of treatment. Obstet Gynecol. 2002;100:408–13.

    Article  CAS  PubMed  Google Scholar 

  72. Bramham K, Thomas M, Nelson-Piercy C, Khamashta M, Hunt BJ. First-trimester low-dose prednisolone in refractory antiphospholipid antibody-related pregnancy loss. Blood. 2011;117(25):6948–51.

    Article  CAS  PubMed  Google Scholar 

  73. Branch DW, Peaceman AM, Druzin M, et al. A multicenter, placebo-controlled pilot study of intravenous immune globulin treatment of antiphospholipid syndrome during pregnancy. The Pregnancy Loss Study Group. Am J Obstet Gynecol. 2000;182:122–7.

    Article  CAS  PubMed  Google Scholar 

  74. Rosove MH, Tabsh K, Wasserstrum N, et al. Heparin therapy for pregnant women with lupus anticoagulant or anticardiolipin antibodies. Obstet Gynecol. 1990;75:630–4.

    CAS  PubMed  Google Scholar 

  75. Silveira LH, Hubble CL, Jara LJ, et al. Prevention of anticardiolipin antibody-related pregnancy losses with prednisone and aspirin. Am J Med. 1992;93:403–11.

    Article  CAS  PubMed  Google Scholar 

  76. Szodoray P, Hajas A, Toth L, Szakall S, Nakken B, Soltesz P, Bodolay E. The beneficial effect of plasmapheresis in mixed connective tissue disease with coexisting antiphospholipid syndrome. Lupus. 2014;23(10):1079–84.

    Article  CAS  PubMed  Google Scholar 

  77. Tsagalis G, Psimenou E, Nakopoulou L, Laggouranis A. Effective treatment of antiphospholipid syndrome with plasmapheresis and rituximab. Hippokratia. 2010;14(3):215–6.

    CAS  PubMed Central  PubMed  Google Scholar 

  78. Miyakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, Cervera R, Derksen RH, De Groot PG, Koike T, Meroni PL, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost. 2006;4:295–306.

    Article  CAS  PubMed  Google Scholar 

  79. El Haieg DO, Zanati MF, El Foual FM. Plasmapheresis and pregnancy outcome in patients with antiphospholipid syndrome. Int J Gynaecol Obstet. 2007;99:236–41.

    Article  PubMed  Google Scholar 

  80. Salmon JE, Girardi G, Lockshin MD. The antiphospholipid syndrome as a disorder initiated by inflammation: implications for the therapy of pregnant patients. Nat Clin Pract Rheumatol. 2007;3:140–7.

    Article  CAS  PubMed  Google Scholar 

  81. Cervera R, Serrano R, Pons-Estel GJ, Ceberio-Hualde L, Shoenfeld Y, de Ramón E, et al.; on behalf of the Euro-Phospholipid Project Group (European Forum on Antiphospholipid Antibodies). Morbidity and mortality in the antiphospholipid syndrome during a 10-year period: a multicentre prospective study of 1000 patients. Ann Rheum Dis. 2014. doi:10.1136/annrheumdis-2013-204838 [Epub ahead of print].

  82. Bucciarelli S, Erkan D, Espinosa G, Cervera R. Catastrophic antiphospholipid syndrome: treatment, prognosis, and the risk of relapse. Clin Rev Allergy Immunol. 2009;36(2–3):80–4.

    Article  CAS  PubMed  Google Scholar 

  83. Berman H, Rodríguez-Pintó I, Cervera R, Morel N, Costedoat-Chalumeau N, Erkan D, et al.; Catastrophic Antiphospholipid Syndrome (CAPS) Registry Project Group (European Forum on Antiphospholipid Antibodies). Rituximab use in the catastrophic antiphospholipid syndrome: descriptive analysis of the CAPS registry patients receiving rituximab. Autoimmun Rev. 2013;12(11):1085–90.

    Google Scholar 

  84. Mar N, Kosowicz R, Hook K. Recurrent thrombosis prevention with intravenous immunoglobulin and hydroxychloroquine during pregnancy in a patient with history of catastrophic antiphospholipid syndrome and pregnancy loss. J Thromb Thrombolysis. 2014;38(2):196–200.

    Article  PubMed  Google Scholar 

  85. Espinosa G, Berman H, Cervera R. Management of refractory cases of catastrophic antiphospholipid syndrome. Autoimmun Rev. 2011;10(11):664–8.

    Article  PubMed  Google Scholar 

  86. Shapira I, Andrade D, Allen SL, Salmon JE. Brief report: induction of sustained remission in recurrent catastrophic antiphospholipid syndrome via inhibition of terminal complement with eculizumab. Arthritis Rheum. 2012;64:2719–23.

    Article  CAS  PubMed  Google Scholar 

  87. Wheeler AP, Bernard GR. Treating patients with severe sepsis. N Engl J Med. 1999;340:207–14.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Thrombotic Microangiopathy, Department of Haematology, University College London Hospitals NHS Foundation Trust, Whitfield St., London, W1T 4EU, UK

    Marie Scully MBChB,BSc(Hons),MD,MRCP,FRCPath

  2. Institute for Women’s Health, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1, UK

    Patrick O’Brien MBBCh, FRCOG, FICOG, FFSRH

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  1. Marie Scully MBChB,BSc(Hons),MD,MRCP,FRCPath
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  2. Patrick O’Brien MBBCh, FRCOG, FICOG, FFSRH
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Correspondence to Marie Scully MBChB,BSc(Hons),MD,MRCP,FRCPath .

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Editors and Affiliations

  1. Department of Haematology, University College London Hospitals NHS Foundation Trust, London, United Kingdom

    Hannah Cohen

  2. Institute for Women's Health, University College London Hospitals NHS Foundation Trust, London, United Kingdom

    Patrick O'Brien

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Scully, M., O’Brien, P. (2015). Thrombotic Microangiopathies in Pregnancy. In: Cohen, H., O'Brien, P. (eds) Disorders of Thrombosis and Hemostasis in Pregnancy. Springer, Cham. https://doi.org/10.1007/978-3-319-15120-5_17

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  • DOI: https://doi.org/10.1007/978-3-319-15120-5_17

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