Maternal extracellular vesicles and platelets promote preeclampsia via inflammasome activation in trophoblasts

Maternal extracellular vesicles and platelets promote preeclampsia via inflammasome activation in trophoblasts

Shrey Kohli, Satish Ranjan, Juliane Hoffmann, Muhammed Kashif, Evelyn A. Daniel, Moh'd Mohanad Al-Dabet, Fabian Bock, Sumra Nazir, Hanna Huebner, Peter R. Mertens, Klaus-Dieter Fischer, Ana C. Zenclussen, Stefan Offermanns, Anat Aharon, Benjamin Brenner, Khurrum Shahzad, Matthias Ruebner and Berend Isermann.

Blood. 2016; 128:2153-2164; doi:10.1182/blood-2016-03-705434

Evaluation and management of acute menorrhagia in women with and without underlying bleeding disorders: consensus from an international expert panel.

James AH, Kouides PA, Abdul-Kadir R, Dietrich JE, Edlund M, Federici AB, et al. Evaluation and management of acute menorrhagia in women with and without underlying bleeding disorders: consensus from an international expert panel. Eur J Obstet Gynecol Reprod Biol. 2011; 158:124-34

Acute menorrhagia is a common gynecological disorder. Prevalence is high among women with inherited bleeding disorders and recent guidance for optimal management is lacking. Following a comprehensive review of the literature, an international expert panel in obstetrics, gynecology and hematology reached consensus on recommendations regarding the management of acute menorrhagia in women without a diagnosed bleeding disorder, as well as in patients with von Willebrand disease, platelet function disorders and other rare hemostatic disorders. The causes and predictors of acute menorrhagia are discussed and special consideration is given for the treatment of women on anticoagulation therapy. This review and accompanying recommendations will provide guidance for healthcare practitioners in the emergency management of acute menorrhagia. 

Thrombocytopenia and disorders of platelet function in pregnancy. Semin Thromb Hemost. 2011 Sep;37(6): 640-52. Epub 2011 Nov 18. Review.

Pregnancy is associated with physiological and pathological changes in platelet numbers and function, which can be of clinical concern because of risks for maternal and fetal or neonatal bleeding. Thrombocytopenia in pregnancy is frequently encountered and may be due to increased platelet turnover and plasma dilution, immune-mediated mechanisms, or a complication of a more severe underlying pregnancy-related disorder such as preeclampsia. Inherited defects in platelet function and number may also manifest during pregnancy with the risk of bleeding dependent on the underlying problem. In some women, the diagnosis of thrombocytopenia will precede pregnancy but in others, the problem is first identified when routine pregnancy blood tests are performed. An accurate diagnosis and risk assessment in the antenatal period are essential for developing specific plans for any antenatal interventions and for management of delivery and the postpartum periods, and the neonate. Management of pregnant women with platelet disorders requires a multidisciplinary approach and close collaboration between the obstetric and hematology teams.

Overview of bleeding disorders in adolescent females with menorrhagia. J Pediatr Adolesc Gynecol. 2010 Dec;23(6):S15-S21.

Ahuja SP, Hertweck SP. Overview of bleeding disorders in adolescent females with menorrhagia. J Pediatr Adolesc Gynecol 2010 Dec;23(6):S15-S21.

Women bleed with menses, during childbirth, and after childbirth. Women are more likely to manifest a bleeding disorder as they have more opportunities to experience bleeding challenges in their lifetime. Bleeding disorders such as hemophilia and von Willebrand disease affect 2.5–3 million American women. The most common inherited bleeding disorder in the population is von Willebrand disease with an estimated prevalence of 1–2%. von Willebrand factor (vWF) is required to adhere platelets to exposed subendothelium and protects factor VIII from proteolysis in the circulation. The prevalence of vWF rises in studies involving women with menorrhagia, with estimates ranging as high as 10–20% in white women, and 1–2% among African American women. Other bleeding disorders seen in adolescents with menorrhagia are disorders of inherited platelet dysfunction, clotting factor deficiencies, thrombocytopenia, and disorders of the fibrinolytic pathway. Not only are women more likely to present early in their life with a bleeding disorder, they are also more likely to have other gynecologic manifestations as a result of these disorders. This article presents an overview of the problem and touches upon the different management strategies available.