Frequency of Protein C, S and Antithrombin III Deficiency and Presence of Antibodies of Antiphospholipid Syndrome in Women with Recurrent Abortion

Document Type : Original Article

Authors

1 M.Sc. student, Department of Hematology and Blood Bank, School of Allied medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Associate professor, Department of Hematology and Blood Bank, School of Allied medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

3 Assistant professor, Departments of Genetic and Pathology, Faculty of Medicine, Baghiatollah University of Medical Sciences, Tehran, Iran.

4 Associate professor, Department of Biostatics, School of Allied medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

5 Associate professor, Department of Hematology and Blood Bank, HSCT research center, School of Allied medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Abstract

Introduction: Recurrent abortion is defined as three or more spontaneous miscarriages before first trimester of pregnancy. Protein C, S, Antithrombin III deficiency is of the min factors of this disease. The presence of antiphospholipid antibodies, such as Lupus Anticoagulant, antiphospholipid, anticardiolipineand and B2 glycoprotein can lead to recurrent abortion.  This study was performed with aim to determine the serum level of these factors in women with recurrent abortion.
Methods: This cross-sectional study was performed in 2017 on 80 women with recurrent abortion who had abortion at first trimester of pregnancyand had referred to gynecology clinic. Clotting method was used to determine theprevalence of deficiency of natural anticoagulant proteins.ELIZA method was used to determine the presence of antibodies ofantiphospholipidsyndrome. Data were analyzed by SPSS software (version 22) and t-test. PResults: Activated Protein C-Resistance was found in 21.3% of cases, prevalence of PS deficiency and PC deficiency individually with 8.8%, component PSD and PCD in 3.7% and AT-III deficiency in 1.3% of patients. Presence of LAC in our patients was 3.8%. The prevalence of APA, LAC, ACA and B2 microglobulin were 2.5%, 3.8%, 1.3 and 2.5% respectively.
Conclusion: APC-R was the most common deficiency of natural coagulant inhibitors in women with recurrent abortion who referred to clinical laboratory of Bagheatalah general hospital in Tehran.

Keywords

References

  1. Tulppala M, Ylikorkala O. Recurrent spontaneous abortion: where do we stand now? Ann Med 1991; 23(6):603-4.
  2. Tulppala M, Palosuo T, Ramsay T, Miettinen A, Salonen R, Ylikorkala O. A prospective study of 63 couples with a history of recurrent spontaneous abortion: contributing factors and outcome of subsequent pregnancies. Hum Reprod 1993; 8(5):764-70.
  3. Baek KH, Lee EJ, Kim YS. Recurrent pregnancy loss: the key potential mechanisms. Trends Mol Med 2007; 13(7):310-7.
  4. Ghorbani M, Hamidpour M, Nematallahi MR, Niazkar HR. Comparison of two methods for factor five Leiden detection in patients with thromboembolism. Biomed Res 2018; 29(8):1685-8.
  5. Bayat F, Amir Aliakbari S, Dabiri A, Nasiri M, Osat Mellati A. The correlation between blood biomarkers and blood lead levels in preeclampsia. Iran J Obstet Gynecol Infertil 2016; 19(34):10-7. (Persian).  
  6. Ghomian N, Maleki A. Thrombotic thrombocytopenic purpura and pregnancy and the outcomes of the next pregnancy: a case report. Iran J Obstet Gynecol Infertil 2016; 19(32):20-4. (Persian).
  7. Younis JS, Brenner B, Ohel G, Tal J, Lanir N, Ben-Ami M. Activated protein C resistance and factor V Leiden mutation can be associated with first-as well as second-trimester recurrent pregnancy loss. Am J Reprod Immunol 2000; 43(1):31-5.
  8. Bick RL. Recurrent miscarriage syndrome due to blood coagulation protein/platelet defects: prevalence, treatment and outcome results. DRW Metroplex Recurrent Miscarriage Syndrome Cooperative Group. Clin Appl Thromb Hemost 2000; 6(3):115-25.
  9. Kempf Haber M, Klimek M. Thrombophilia in pregnancy and its influence on venous thromboembolism and recurrent miscarriages. Przegl Lek 2005; 62(3):164-8.
  10. Egesel T, Büyükasik Y, Dündar SV, Gürgey A, Kirazli S, Bayraktar Y. The role of natural anti-coagulant deficiencies and factor V Leiden in the development of idiopathic portal vein thrombosis. J Clin Gastroenterol 2000; 30(1):66-71.
  11. Bovill EG, Bauer KA, Dickerman JD, Callas P, West B. The clinical spectrum of heterozygous protein C deficiency in large New England kindred. Blood 1989; 73(3):712-7.
  12. Galli M, Luciani D, Bertolini G, Barbui T. Lupus anticoagulants are stronger risk factors for thrombosis than anticardiolipin antibodies in the antiphospholipid syndrome: a systematic review of the literature. Blood 2003; 101(5):1827-32.
  13. Vossen C, Conard J, Fontcuberta J, Makris M, Van Der Meer FJ, Pabinger I, et al. Risk of a first venous thrombotic event in carriers of a familial thrombophilic defect. The European Prospective Cohort on Thrombophilia (EPCOT). J Thromb Haemost 2005; 3(3):459-64.
  14. Sajjadieh MR, Viunytska LV. Anti-thrombin-III as a non-invasive marker of chronic liver disease. Hepat Mon 2009; 9:128-32.
  15. Johnston A, Aboud M, Morel-Kopp MC, Coyle L, Ward CM. Use of a functional assay to diagnose protein S deficiency; inappropriate testing yields equivocal results. Intern Med J 2007; 37(6):409-11.
  16. Dahlback B. The tale of protein S and C4b binding protein, a story of affection. Thromb Haemost 2007; 98(1):90-6.
  17. Heijboer H, Brandjes DP, Büller HR, Sturk A, ten Cate JW. Deficiencies of coagulation inhibiting and fibrinolytic proteins in outpatients with deep-vein thrombosis. New Engl J Med 1990; 323(22):1512-16.
  18. Gaman AM. Găman G. Deficiency of anti-thrombin III (AT III)-case report and review of the literature. Current Health Sci J 2014; 40(2):141-9.
  19. Hansda J, Roychowdhury J. Study of thrombophilia in recurrent pregnancy loss. J Obstet Gynecol India 2012; 62(5):536-40.
  20. Perry SL, Ortel TL. Clinical and laboratory evaluation of thrombophilia. Clin Chest Med 2003; 24(1):153-70.
  21. Miljić P, Rolović Z, Elezović I, Antunović P, Stanojević M, Colović M. Hereditary deficiency of antithrombin III, protein C, protein S and factor XII in 121 patients with venous or arterial thrombosis. Srpski Arhiv Celokupno Lekarstvo 1999; 127(1-2):21-7.
  22. Salmanpoor Z, Ahmadi Nejad M, Bashash D, Hamidpoor M, Zolfaghari S, Ahmadi F. Investigating the frequency of resistance to activated protein C and protein S, C and antithrombin deficiencies in patients with deep vein thrombosis referred to the Iranian blood transfusion organization. J Zanjan Univ Med Sci 2017; 25(112):21-9. (Persian).
  23. Nizankowska-Mogilnicka E, Adamek L, Grzanka P, Domagala TB, Sanak M, Krzanowski M, et al. Genetic polymorphisms associated with acute pulmonary embolism and deep venous thrombosis. Eur Respir J 2003; 21(1):25-30.
  24. Hamidpour M, Jahangir H, Safi M, Toogeh G, Allahbakhshian M, Hamidpour R, et al. A study of the natural coagulating inhibitors polymorphism in Iranian patients with the vine thrombosis. Int J 2015; 2(2):47-53.
  25. Sarig G, Younis JS, Hoffman R, Lanir N, Blumenfeld Z, Brenner B. Thrombophilia is common in women with idiopathic pregnancy loss and is associated with late pregnancy wastage. Fertil Steril 2002; 77(2):342-7.
  26. Rai R, Shlebak A, Cohen H, Backos M, Holmes Z, Marriott K, et al. Factor V Leiden and acquired activated protein C resistance among 1000 women with recurrent miscarriage. Hum Reprod 2001; 16(5):961-5.
  27. Yokuş O, Balçık ÖŞ, Albayrak M, Ceran F, Yılmaz M, Dağdaş S, et al. Thrombophilic risk factors in women with recurrent abortion. J Clin Exper Invest 2010; 1(3):168-72.
  28. Rey E, Kahn SR, David M, Shrier I. Thrombophilic disorders and fetal loss: a meta-analysis. Lancet 2003; 361(9361):901-8.
  29. Jatuworapruk K, Bhoopat L, Hanvivadhanakul P. Clinical and immunological characteristics of antiphospholipid syndrome in an Asian population: a retrospective study. Asian Pac J Allergy Immunol 2018; 10:1-7.
  30. Laranjeira MR. Clinical and prognostic implications of the presence of other prothrombotic factors in patients with Antiphospholipid Syndrome: a single center cohort analysis. Porto: Faculdade de Medicina da Universidade do Porto; 2018.
The Iranian Journal of Obstetrics, Gynecology and Infertility
Volume 22, Issue 5
July 2019
Pages 71-77

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