Miscarriages Caused by Blood Coagulation Protein or Platelet Deficits 

  • Author: Rodger L Bick†, MD, PhD, FACP; Chief Editor: Emmanuel C Besa, MD   more...
 
Updated: Nov 28, 2011
 

Background

Recurrent miscarriage syndrome (RMS) is a common obstetric problem, affecting over 500,000 women in the United States per year[1] ; infertility, although less well defined epidemiologically, is also a common clinical problem.

For excellent patient education resources, visit eMedicine's Women's Health Center and Pregnancy and Reproduction Center. Also, see eMedicine's patient education articles Miscarriage, Threatened Miscarriage, and Infertility.

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Pathophysiology

RMS due to blood protein or platelet defects may come about through 2 mechanisms: (1) those disorders that are associated with a hemorrhagic tendency or (2) those defects that are associated with a thrombotic tendency. Hemorrhagic (bleeding) defects that are associated with RMS are rare, whereas thrombotic or hypercoagulable/thrombophilic defects are extremely common.[2, 3] The hemorrhagic defects associated with fetal wastage syndrome presumably lead to inadequate fibrin formation, thus precluding adequate implantation of the fertilized ovum into the uterus.

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Epidemiology

Frequency

United States

RMS affects more than 500,000 women in the United States per year.[1]

Race

Females of any race can be affected by RMS.

Sex

Only females are affected by RMS.

Age

Females of childbearing age

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Proceed to Clinical Presentation
 
 
Contributor Information and Disclosures
Author

Rodger L Bick†, MD, PhD, FACP  Former Clinical Professor of Medicine, University of Texas Southwestern Medical Center; Former 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.

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: Medscape Salary Employment

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 Association for the Advancement of Science, American Association of Blood Banks, American Clinical and Climatological Association, American Society for Clinical Pathology, American Society of Hematology, College of American Pathologists, International Society of Blood Transfusion, International Society on Thrombosis and Haemostasis, and Royal College of Physicians and Surgeons of Canada

Disclosure: Glaxo Smith Kline Honoraria Speaking and teaching; Talecris Honoraria Board membership

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, Jefferson Medical College of 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 Clinical Oncology, American Society of Hematology, and New York Academy of Sciences

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) Mean Standard Deviation Maximum Minimum
Age, y33.35.634918
Number of Miscarriages2.92.3992
Table 2. Clotting Disorders Found in the Authors' Population
Antiphospholipid Found Patients 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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