eMedicine Specialties > Hematology > Coagulation, Hemostasis, and Disorders

Miscarriages Caused by Blood Coagulation Protein or Platelet Deficits: Differential Diagnoses & Workup

Author: Rodger L Bick, MD, PhD, FACP, Clinical Professor of Medicine, University of Texas Southwestern Medical Center; Director, Dallas and Pacific Thrombosis Hemostasis and Vascular Medicine Clinical Center
Contributor Information and Disclosures

Updated: Jul 1, 2008

Differential Diagnoses

Other Problems to Be Considered

A coagulation defect is the single, most common cause of recurrent miscarriage (2 or more miscarriages), after hormonal defects and anatomic defects have been eliminated as the cause. Recurrent miscarriage, based upon the available literature and our experience, is generally due to well-defined defects, as follows1 :

  • About 15% are due to hormonal abnormalities (progesterone, estrogens, diabetes, or thyroid disease
  • About 10% are due to anatomic abnormalities
  • About 7% are secondary to chromosomal abnormalities
  • About 6% cannot be explained
  • The remainder, about 55-62%, are due to blood coagulation protein/platelet defects.

The approximate prevalence of causes of RMS and infertility is summarized in the image below.1 These are in contrast to first-time miscarriage, which in most cases, is due to a chromosomal defect and may affect up to 25% of first-time pregnancies.1

Defects causing recurrent miscarriage.

Defects causing recurrent miscarriage.

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Defects causing recurrent miscarriage.

Defects causing recurrent miscarriage.


Workup

Laboratory Studies

  • If the patient has a history of bleeding, the following tests should be ordered:
    • Platelet count
    • Prothrombin time (PT)
    • Activated partial thromboplastin time (aPTT)
    • Platelet function testing (aggregation)
    • von Willebrand evaluation
    • Factor XIII function and antigen
  • If there is no history of bleeding, an antiphospholipid panel should be ordered.

More on Miscarriages Caused by Blood Coagulation Protein or Platelet Deficits

Overview: Miscarriages Caused by Blood Coagulation Protein or Platelet Deficits
Differential Diagnoses & Workup: Miscarriages Caused by Blood Coagulation Protein or Platelet Deficits
Treatment & Medication: Miscarriages Caused by Blood Coagulation Protein or Platelet Deficits
Follow-up: Miscarriages Caused by Blood Coagulation Protein or Platelet Deficits
Multimedia: Miscarriages Caused by Blood Coagulation Protein or Platelet Deficits
References
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References

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Further Reading

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Keywords

recurrent miscarriage, recurrent miscarriage syndrome, RMS, fetal wastage syndrome, recurrent fetal loss, antiphospholipid syndrome, APLS, factor XIII deficiency, factor XII defects, factor X deficiency, factor VII deficiency, factor V deficiency, factor V Leiden, factor II (prothrombin) deficiency, von Willebrand syndrome, hemophilia, fibrinogen defects, afibrinogenemia, sticky platelet syndrome,

5,10-methyltetrahydrofolate reductase mutations, MTHFR mutations, C677T, hyperhomocysteinemia, PAI-1 elevation / polymorphisms, protein S deficiency, prothrombin G20210A,protein C deficiency, antithrombin deficiency, heparin cofactor II deficiency, tissue plasminogen activator deficiency, TPA deficiency, lipoprotein (a), immune vasculitis, annexin-V, annexin V, placental anticoagulant protein, dalteparin, Fragmin

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Contributor Information and Disclosures

Author

Rodger L Bick, MD, PhD, FACP, Clinical Professor of Medicine, University of Texas Southwestern Medical Center; Director, Dallas and Pacific Thrombosis Hemostasis and Vascular Medicine Clinical Center
Rodger L Bick, MD, PhD, FACP is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Association of Blood Banks, American Cancer Society, American College of Angiology, American College of Physicians, American Geriatrics Society, American Heart Association, American Medical Association, American Society for Clinical Pathology, American Society of Hematology, Association of Clinical Scientists, California Medical Association, California Thoracic Society, International College of Angiology, International Society of Hematology, International Society on Thrombosis and Haemostasis, New York Academy of Sciences, and Southwest Oncology Group
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Ronald A Sacher, MB, BCh, MD, FRCPC, Professor, Internal Medicine and Pathology, Director, Hoxworth Blood Center, University of Cincinnati Academic Health Center
Ronald A Sacher, MB, BCh, MD, FRCPC is a member of the following medical societies: American Society of Hematology
Disclosure: Glaxo Smith Kline Honoraria Speaking and teaching; Talecris Honoraria Board membership

CME Editor

Rajalaxmi McKenna, MD, FACP, Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan Hospital, Advocate Health Systems
Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis
Disclosure: Nothing to disclose.

Chief Editor

Emmanuel C Besa, MD, Professor, Department of Medicine, Division of Hematologic Malignancies, Kimmel Cancer Center, Thomas Jefferson University
Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education, American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Hematology, and New York Academy of Sciences
Disclosure: Nothing to disclose.

 
 
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