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Miscarriages Caused by Blood Coagulation Protein or Platelet Deficits Differential Diagnoses

  • Author: George Ansstas, MD; Chief Editor: Perumal Thiagarajan, MD  more...
 
Updated: Oct 21, 2015
 
 

Diagnostic Considerations

A coagulation defect is the single, most common cause of recurrent miscarriage (two 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 follows[1] :

  • 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 recurrent miscarriage syndrome 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.
 
 
Contributor Information and Disclosures
Author

George Ansstas, MD Instructor of Medicine, Attending Physician in Leukemia and Bone Marrow Transplant and Oncology, Washington University School of Medicine

George Ansstas, MD is a member of the following medical societies: American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Ronald A Sacher, MB, BCh, FRCPC, DTM&H Professor, Internal Medicine and Pathology, Director, Hoxworth Blood Center, University of Cincinnati Academic Health Center

Ronald A Sacher, MB, BCh, FRCPC, DTM&H is a member of the following medical societies: American Association for the Advancement of Science, American Association of Blood Banks, American Society for Clinical Pathology, American Society of Hematology, College of American Pathologists, International Society on Thrombosis and Haemostasis, Royal College of Physicians and Surgeons of Canada, American Clinical and Climatological Association, International Society of Blood Transfusion

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: GSK Pharmaceuticals,Alexion,Johnson & Johnson Talecris,,Grifols<br/>Received honoraria from all the above companies for speaking and teaching.

Chief Editor

Perumal Thiagarajan, MD Professor, Department of Pathology and Medicine, Baylor College of Medicine; Director, Transfusion Medicine and Hematology Laboratory, Michael E DeBakey Veterans Affairs Medical Center

Perumal Thiagarajan, MD is a member of the following medical societies: American College of Physicians, American Society for Clinical Investigation, Association of American Physicians, American Society for Biochemistry and Molecular Biology, American Heart Association, American Society of Hematology, Royal College of Physicians

Disclosure: Nothing to disclose.

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Defects causing recurrent miscarriage.
Dallas/Fort Worth Metroplex (DFW Metroplex) flow protocol.
Table 1. Characteristics of the First 351 Women Referred for Hemostasis Evaluation
Patient Characteristics (All 351 Patients)MeanStandard DeviationMaximumMinimum
Age, y33.35.634918
Number of Miscarriages2.92.3992
Table 2. Clotting Disorders Found in the Authors' Population
Antiphospholipid FoundPatients With APLS, %
ACLA-IgG only32.6
ACLA-IgM only23.4
ACLA-IgA only7
ACLA-IgG + IgM3
ACLA-IgG + IgA1
ACLA IgA + IgM0
Lupus anticoagulant only2
ACLA + lupus anticoagulant2
Subgroup Only (No ACLA or lupus anticoagulant present) 
Antiphosphatidylserine4
Antiphosphatidylinositol2
Antiphosphatidylethanolamine5
Antiphosphatidic acid5
Antiphosphatidylcholine7
Antiphosphatidylglycerol1
Anti-annexin-V5
B2GP10
Hexagonal phospholipid0
Total 
(9 Patients had ACLA + a subgroup antibody) 
Total with only a subgroup antibody 
APLS patients with only a subgroup antibody, %29
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