Events

Lecture - Recurrent Fetal Loss

FML at EOFF 2012 in Dubai

Differential Diagnosis in Antiphospholipid Syndrome and other Prothrombic Conditions in Recurrent Fetal Loss

Associate Professor Michaela Jaksch, MD PhD
Freiburg Medical Laboratory ME LLC, Dubai

Abstract

Antiphospholipid syndrome (APS) in pregnancy is characterized by the presence of autoantibodies and can be associated with recurrent fetal loss (RFL). Other complications such as preeclampsia, fetal growth retardation, or placental insufficiency might occur. Reviewing the literature of the past 2 decades, a clear standardization does not exist in the diagnosis of APS. This syndrome constitutes a heterogeneous group of circulating antibodies against phospholipids with the most important ones being anticardiolipin antibodies (ACA), and lupus anticoagulants. A futher differential diagnosis in patients with APS presenting with thrombocytopenia includes thrombotic thrombocytopenic purpura (TTP), heparin-induced thrombocytopenia (HIT) and disseminated intravascular coagulation (DIC).

Hereditary thrombophilia is mainly due to antithrombin deficiency, protein C and protein S deficiencies, the activated protein C resistance (mostly due to factor Ⅴ Leiden mutation)  or the prothrombin (factor II) mutation. In 1999 Brenner et al. identified thrombophilia as a major cause in more than 40% of women affected by RFL. Following studies confirmed the increased frequency of antithrombin III, protein C, and protein S deficiency in women with RFL. Especially the factor V Leiden gene mutation and the prothrombin A20210G gene mutation play an essential role. Several reports have described an association between early recurrent fetal loss and hyperhomocysteinemia and/or MTHFR C677T gene polymorphism. Acquired thrombophilia has also been associated with RFL.

This lecture will provide an updated overview on APS and other coagulation related abnormalities during pregnancy and their diagnostic possibilities.