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:

(62.50%)

SPS:

(16.20%)

Protein S deficiency:

(8.70%)

TPA deficiency:

(8.70%)

APC resistance:

(2.50%)

PAI-1 defect:

(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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