Abordagem laboratorial das síndromes antifosfolípide e do aborto recorrente

Barra lateral de artigos

PDF
Publicado: ago 14, 2010
DOI: https://doi.org/10.7322/abcs.v35i2.96
Palavras-chave:
Síndrome antifosfolipídica, aborto habitual, inibidor de coagulação do lúpus, anticorpos anticardiolipina

Conteúdo do artigo principal

Juliane Cristina Trevisan Sanches
Curso de Especialização em Análises Clínicas do Instituto de Pesquisa e Educação em Saúde de São Paulo (IPESSP), São Paulo (SP), Brasil.
Luciana Zambeli Caputto
Laboratório Chromos de Citogenética, São Paulo (SP), Brasil.
Alexandre Luiz Affonso Fonseca
Curso de Especialização em Análises Clínicas do Instituto de Pesquisa e Educação em Saúde de São Paulo (IPESSP), São Paulo (SP), Brasil.
Enny Fernandes Silva
Disciplina de Bioquímica da Faculdade de Farmácia e Bioquímica da Universidade Paulista (Unip), São Paulo (SP), Brasil.
Fernando Luiz Affonso Fonseca
Laboratório de Análises Clínicas da Disciplina de Hematologia e Oncologia da Faculdade de Medicina do ABC (FMABC), Santo André (SP), Brasil.

Resumo

Um aumento no potencial hemostático endometrial ocorre durante o ciclo menstrual, possibilitando, assim, a implantação embrionária, caso ocorra a fertilização. Defeitos nas proteínas de coagulação podem alterar esse estado de hipercoagulabilidade gestacional e desencadear perdas fetais por falhas na implantação ou na nutrição do embrião. A síndrome do aborto recorrente pode ser ocasionada por inúmeros fatores, entre eles anormalidades cromossômicas, anatômicas ou hormonais, ou ainda por defeitos nas proteínas de coagulação sanguínea ou plaquetária. Uma causa comum de abortos recorrentes é a síndrome antifosfolípide, uma desordem sistêmica, autoimune, caracterizada por trombose arterial e/ou venosa, morte fetal, abortos recorrentes e trombocitopenia, acompanhada de títulos elevados de anticorpos antifosfolípides: anticoagulante lúpico e/ou anticardiolipina. Pela íntima associação dessas síndromes, faz-se necessário investigá-las em pacientes que procuram os tratamentos de fertilização in vitro.

Detalhes do artigo

Edição
v. 35 n. 2 (2010)
Seção
Artigos de Revisão

Referências

Glueck CJ, Awadalla SG, Phillips H, Cameron D, Wang P, Fontaine RN. Polycistic ovary syndrome, infertility, familial thrombophilia, familial hypofibrinolysis, recurrent loss of in vitro fertilized embryos, and miscarriage. Fertil Steril. 2000;74(2):394-7. http://dx.doi.org/10.1016/S0015-0282(00)00630-0

Grandone E, Colaizzo D, Lo Bue A, Checola MG, Cittadini E, Margaglione M. Inherited thrombophilia and in vitro fertilization implantation failure. Fertil Steril. 2001;76(1):201-2. http://dx.doi.org/10.1016/S0015-0282(01)01832-5

Torry DS, Leavenworth J, Chang M, Maheshwari V, Groesch K, Ball ER et al. Angiogenesis in implantation. J Assist Reprod Genet. 2007;24(7):303-15. http://dx.doi.org/10.1007/s10815-007-9152-7

Brenner B. Haemostatic changes in pregnancy. Tromb Res. 2004;114(5- 6):409-14.

Lockwood CJ, Nemerson Y, Guller S, Krikun G, Alvarez M, Hausknecht V et al. Progestational regulation of human endometrial stromal cell tissue factor expression during decidualization. J Clin Endocrinol Metab. 1993;76(1):231-6.

Runic R, Schatz F, Krey L, Demopoulos R, Thung S, Wan L et al. Alterations in endometrial stromal cells tissue factor protein and messenger ribonucleic acid expression in patients experiencing abnormal uterine bleeding while using Norplant-2 contraception. J Clin Endocrinol Metab. 1997;82(6):1983-8.

Lockwood CJ, Krikun G, Papp C, Toth-Pal E, Markiewicz L, Wang EY et al. The role of progestationally regulated stromal cell tissue factor and type-1 plasminogen activator inhibitor (PAI-1) in endometrial hemostasis and menstruation. Ann NY Acad Sci. 1994;734:57-79. http://dx.doi.org/10.1111/j.1749-6632.1994.tb21736.x

Nemerson Y. Tissue factor and hemostasis. Blood. 1988;71(1):1-8.

Lorenzi TF. Manual de Hematologia: propedêutica e clínica. 4ª ed. Rio de Janeiro: Guanabara Koogan; 2006.

Drake TA, Morrissey JH, Edgington TS. Selective cellular expression of tissue factor in human tissues. Implications for disorders of hemostasis and thrombosis. Am J Pathol. 1989;134(5):1087-97.

Guha A, Bach R, Konigsberg W, Nemerson Y. Affinity purification of human tissue factor: interaction of factor VII and tissue factor in detergent micelles. Proc Natl Acad Sci USA. 1986;83(2):299-302. http://dx.doi.org/10.1073/pnas.83.2.299

Bach RR. Initiation of coagulation by tissue factor. CRC Critc Rev Biochem. 1988;23(4):339-68. http://dx.doi.org/10.3109/10409238809082548

Moore KL, Persaud TVN. Embriologia Clínica. 7ª ed. Rio de Janeiro: Elsevier; 2004.

Sadler TW. Embriologia Médica. 9ª ed. Rio de Janeiro: Guanabara Koogan; 2005.

Lockwood CJ, Krikun G, Caze R, Rahman M, Buchwalder LF, Schatz F. Decidual cell-expressed tissue factor in human pregnancy and its involvement in hemostasis and preeclampsia-related angiogenesis. Ann N Y Acad Sci. 2008;1127:67-72. http://dx.doi.org/10.1196/annals.1434.013

Krabbendam I, Franx A, Bots ML, Fijnheer R, Bruinse HW. Thrombophilias and recurrent pregnancy loss: a critical appraisal of the literature. Eur J Obstet Gynecol Reprod Biol. 2005;118(2):143-53. http://dx.doi.org/10.1016/j.ejogrb.2004.07.019

Dusse LM, Carvalho MG, Cooper AJ, Lwaleed BA. Tissue factor and tissue factor pathway inhibitor: a potencial role in pregnancy and obstetric vascular complications? Clin Chim Acta. 2006;372(1-2):43-6. http://dx.doi.org/10.1016/j.cca.2006.03.025

Bick RL, Hoppensteadt D. Recurrent miscarriage syndrome and infertility due to blood coagulation protein/platelet defects: a review and update. Clin Appl Tromb Hemost. 2005;11(1):1-13. http://dx.doi.org/10.1177/107602960501100101

Bick RL. Recurrent miscarriage syndrome and infertility caused by blood coagulation protein or platelet defects. Hematol Oncol Clin North Am. 2000;14(5):1117-31. http://dx.doi.org/10.1016/S0889-8588(05)70174-X

Inbal A, Muszbeck L. Coagulation factor deficiencies and pregnancy loss. Semin Tromb Hemost. 2003;29(2):171-4. http://dx.doi.org/10.1055/s-2003-38832

Kumar M, Mehta P. Congenital coagulophaties and pregnancy: report of four pregnancies in a factor X-deficient woman. Am J Hematol. 1994;46(3): 241-4. http://dx.doi.org/10.1002/ajh.2830460315

Valnícek S, Vacl J, Mrázová M, Soska J, Dvorák R, Bílá K. Hemotherapeutic safeguarding of induced abortion in inborn proconvertin insufficiency (hemagglutination factor VII) using exchange plasmapheresis. Zentralbl Gynakol. 1972;94(29):931-5.

Nelson DB, Ness RB, Grisso JA, Cushman M. 2001. Influence of hemostatic factors on spontaneous abortion. Am J Perinatol. 18(4):195-201. http://dx.doi.org/10.1055/s-2001-15503

Slunský R. Personal experiences with the antifibrinolytic PAMBA in obstetrics and gynecology. Zentralbl Gynakol. 1970;92(12):364-7.

Owen CA Jr, Henriksen RA, McDuffie FC, Mann KG. Prothrombin Quick. A newly identified dysprothrombinemia. Mayo Clin Proc. 1978;53(1): 29-33.

Vora S, Shetty S, Ghosh K. Coagulation factor deficiency as a cause of recurrent fetal loss: a red herring! Blood Coagul Fibrinolysis. 2007;18(6): 571-4 http://dx.doi.org/10.1097/MBC.0b013e328201c8b7

Evron S, Anteby SO, Brzezinsky A, Samueloff A, Eldor A. Congenital afibrinogenemia and recurrent early abortion: a case report. Eur J Obstet Gynecol Reprod Biol. 1985;19(5):307-11. http://dx.doi.org/10.1016/0028-2243(85)90046-2

Bick RL, Baker WF. Antiphospholipid syndrome and thrombosis. Semin Thromb Hemost. 1999;25(3):333-50. http://dx.doi.org/10.1055/s-2007-994935

Schved JF, Gris JC, Neveu S, Dupaigne D, Mares P. Factor XII congenital deficiency and early spontaneous abortion. Fertil Steril. 1989;52(2):335-6.

Klein M, Rosen A, Kyrle P, Beck A. Obstetrical management of dysfibrinogenemia with increased thrombophilia. Geburtshilfe Frauenheilkd. 1992;52(7):442-4. http://dx.doi.org/10.1055/s-2007-1023785

Barkagan ZS, Belykh SI. Protein C deficiency and the multi-thrombotic syndrome associated with pregnancy an abortion. Gematol Transfuziol. 1992;37(9-10):35-7.

Hellgren M. Tengborn L, Abildgaard U. Pregnancy in women with congenital antithrombin III deficiency: experience of treatment with heparin and antithrombin. Ginecol Obstet Invest. 1982;14(2):127-41. http://dx.doi.org/10.1159/000299460

Simioni P, Lazzaro AR, Coser E, Salmistraro G, Girolami A. Hereditary heparin cofactor II deficiency and thrombosis: report of six patients belonging to two separate kindreds. Blood Coagul Fibrinolysis. 1990;1(4- 5):351-6.

Bick RL. Antiphospholipid syndrome in pregnancy. Hematol Oncol Clin North Am. 2008;22(1):107-20. http://dx.doi.org/10.1016/j.hoc.2007.10.008

Santamaria JR, Badziak D, Barros MF, Mandelli FL, Cavalin LC, Sato MS. Síndrome antifosfolípide. An Bras Dermatol. 2005;80(3):225-39. http://dx.doi.org/10.1590/S0365-05962005000300002

Buckingham KL, Chamley LW. A critical assessment of the role of antiphospholipid antibodies in infertility. J Reprod Immunol. 2009;80(1-2):132-45. http://dx.doi.org/10.1016/j.jri.2008.11.005

Wassermann A, Neisser A, Bruck C. Eine serodiagnostiche reaktion bei syfhilis. Deutsche Medicische Wochenschrift. 1906;32:745-6. http://dx.doi.org/10.1055/s-0028-1142018

Pangborn MC. A new serologically active phospholipid from beef heart. Proc Soc Exp Biol Med. 1941;48:484-6. http://dx.doi.org/10.3181/00379727-48-13365P

Conley CL, Hartmann RC. A hemorrhagic disorder caused by circulating anticoagulant in patients with disseminated lupus erythematousus. J Clin Invest. 1952;31:621-2.

Feinstein DI, Rapaport SI. Acquired inhibitors of blood coagulation. Prog Hemost Thromb. 1972;1:75-95.

Bowie EJ, Thompson JH Jr, Pascuzzi CA, Owen CA Jr. Thrombosis in systemic lupus erythematosus despite circulating anticoagulants. J Lab Clin Med. 1963;62:416-30.

Hughes GR. The anticardiolipin syndrome. Clin Exp Rheumatol. 1985;3(4):285-6.

Soligo AGS, Barini R, Carvalho ECC, Annichino-Bizzacchi J. Prevalência dos fatores trombofílicos em mulheres com infertilidade. Rev Bras Ginecol Obstet. 2007;29(5):235-40. http://dx.doi.org/10.1590/S0100-72032007000500003

Sarto A, Rocha M, Geller M, Capmany C, Martinez M, Quintans C et al. Tratamiento con enoxaparina adaptado a los programas de fertilidad en mujeres con aborto recurrente y trombofilia. Medicina (Buenos Aires). 2001;61(4):406-12.

Azem F, Many A, Ben Ami I, Yovel I, Amit A, Lessing JB et al. Increased rates of thrombophilia in women with repeated IVF failures. Hum Reprod. 2004;19(2):368-70. http://dx.doi.org/10.1093/humrep/deh069

Aznar J, Villa P, Espa-a F, Estellés A, Grancha S, Falcó C. Activated protein C resistance phenotype in patients with antiphospholipid antibodies. J Lab Clin Med. 1997;130(2):202-8. http://dx.doi.org/10.1016/S0022-2143(97)90097-4

Schultz DR. Antiphospholipid antibodies: basic immunology and assays. Semin Arthritis Rheum. 1997;26(5):724-39. http://dx.doi.org/10.1016/S0049-0172(97)80041-8

Amengual O, Atsumi T, Khamashta MA, Hughes GR. The role of the tissue factor pathway in the hypercoagulable state in patients with the antiphospholipid syndrome. Thromb Haemost. 1998;79(2):276-81.

Martini A, Ravelli A. The clinical significance of antiphospholipid antibodies. Ann Med. 1997;29(2):159-63. http://dx.doi.org/10.3109/07853899709113704

Bussen SS, Steck T. Thyroid antibodies and their relation to antithrombin antibodies, anticardiolipin antibodies and lupus anticoagulant in women with recurrent spontaneous abortions (antithyroid, anticardiolipin and antithrombin autoantibodies and lupus anticoagulant in habitual aborters). Eur J Obstet Gynecol Reprod Biol. 1997;74(2):139-43. http://dx.doi.org/10.1016/S0301-2115(97)00097-3

Qublan HS, Eid SS, Ababneh HA, Amarin ZO, Smadi AZ, Al-Khafaji FF et al. Acquired and inherited thrombophilia: implication in recurrent IVF and embryo transfer failure. Hum Reprod. 2006;21(10):2694-8. http://dx.doi.org/10.1093/humrep/del203

Rand JH, Wu XX. Antibody-mediated disruption of the annexin-V antithrombotic shield: a new mechanism for thrombosis in the antiphospholipid syndrome. Thromb Haemost. 1999;82(2):649-55.

Aron AL, Gharavi AE, Shoenfeld Y. Mechanisms of action of antiphospholipid antibodies in the antiphospholipid syndrome. Int Arch Allergy Immunol. 1995;106(1):8-12. http://dx.doi.org/10.1159/000236883

Meroni PL, Del Papa N, Borghi MO. Antiphospholipid and antiendothelial antibodies. Int Arch Allergy Immunol. 1996;111(4):320-5. http://dx.doi.org/10.1159/000237387

Harris EN, Khamashta MA, Hughes GRV. Antiphospholipid antibody syndrome. In: Mccarty DJ, Koopman WJ, editors. Arthritis and allied conditions. 13th ed. Philadelphia: Lea & Febiger; 1997. p. 1201-13.

Gharavi AE, Wilson WA. Antiphospholipid antibodies. In: Wallace DJ, Hahn BH, editors. Dubois' lupus erythematosus. 5th ed. Baltimore, MD, USA: Williams & Wilkens; 1997. p. 471-92.

Welsch S, Branch DW. Antiphospholipid syndrome in pregnancy. Obstetric concerns and treatment. Rheum Dis Clin North Am. 1997;23(1):71-84. http://dx.doi.org/10.1016/S0889-857X(05)70315-X