photo of Lenore Goldfarb
recurrent miscarriage

IMMUNE TESTING

GENETICS

RECURRENT MISCARRIAGE:
CAUSES, EVALUATION,
AND TREATMENT

Introduction

Chromosomal Abnormalities

Blood Coagulation Protein
or Platelet Defects

Hemorrhagic Defects

Thrombotic Defects

Anatomic Abnormalities

Endocrine Abnormalities

References

-Tables

ADDITIONAL READING

References for: Causes, evaluation, and treatment.

Medscape Women's Health 1998 May;3(3):2 (ISSN: 1521-2076)
Bick RL; Madden J; Heller KB; Toofanian A

Thrombosis Clinical Center, Department of Medicine (Hematology & Oncology),
Presbyterian Hospital of Dallas, Tex., USA.

Table 1. Profile of 118 Women Having Recurrent Fetal Loss

Mean Age: 34 years
Mean Number of Miscarriages at Diagnosis: 3
Frequency of Defects Noted
Antiphospholipid syndrome: 50 (62.50%)
SPS: 13 (16.20%)
Protein S deficiency: 7 (8.70%)
TPA deficiency: 7 (8.70%)
APC resistance: 2 (2.50%)
PAI-1 defect: 1 (1.25%)
APC = activated protein C PAI-1 = type 1 plasminogen activator
SPS = sticky platelet syndrome TPA = tissue plasminogen activator


Table 2. Two-Stage Evaluation of RFL When Blood-Protein and Platelet Defects Are Suspected

Blood-Protein/Platelet Factor (Technique/Assay)
Stage I
Perform complete history and physical exam. Send serum for CBC and panel I blood protein and coagulation studies.
Panel I
  • Prothrombin time
  • Activated partial thromboplastin time
  • Anticardiolipin antibodies (solid-phase ELISA) IgG, IgA, IgM idiotypes
  • Lupus anticoagulant with phospholipid confirmation (dRVVT)
  • Functional protein S (immunologic and free)
  • C4b-binding protein (if functional protein S is low)
  • Protein C (chromogenic technique)
  • Factor XIII (immunoassay)
  • Antithrombin (chromogenic technique)
  • Sticky platelet syndrome (SPS)
  • Plasminogen (chromogenic technique)
  • Activated protein C resistance (Dahlback method16)
  • Functional fibrinogen
Stage II
Evaluate serum sample for blood protein defects more rarely associated with RFL.
Panel II
  • Plasminogen activator inhibitor type 1 (PAI-1)
  • Tissue plasminogen activator
  • Heparin cofactor II
  • Tissue factor pathway inhibitor
  • Blood and urine homocysteine

dRVVT= dilute Russel's viper venom time; ELISA = enzyme-linked immunosorbent assay; Ig = immunoglobulin.

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