Predictive value of thrombopath determination in women with infertility and pregnancy complications

Liver transplantation for congenital protein C deficiency with initial poor graft function: a case report with literature review

Congenital deficiency of protein C (PC) is a rare disease that causes thrombophilia during the neonatal and infantile periods. Despite anticoagulative treatments, purpura fulminans and major vessel thrombosis often occur. We report a 7-year-old girl with congenital PC deficiency who underwent deceased donor liver transplantation (LT) and experienced complications accompanied by initial poor graft function (IPGF). Before LT, she had cerebral and ophthalmic hemorrhage, and seven episodes of purpura fulminans. The operation was successfully performed; however, the liver graft developed IPGF. Hyperammonemia and coagulopathy required continuous hemodiafiltration and infusion of fresh frozen plasma. It took 22 days for PC activity to reach reference levels. The changes in clotting and anticlotting activities in the patient's plasma were revealed using clot waveform analysis and the HemosIL ThromboPath^® assay. PC activity remained normal for 5 years after LT. Even when IPGF occurs, liver function including PC activity can remain normal for a long time after recovery from IPGF. LT can be a curative treatment for congenital PC deficiency.

Prevalence of thromogenic gene mutations in women with recurrent miscarriage: A retrospective study of 1,507 patients

Objective

Thromogenic gene mutations has been thought to be associated with recurrent pregnancy loss in women in Turkey. The aim of this study was to investigate the prevalence of thromogenic gene mutations such as factor V Leiden (FVL, G1691T), prothrombin (G20210A), and the methylene tetrahydrofolate reductase (MTHFR, C677T) mutation in women with recurrent pregnancy loss.

Methods

This descriptive study was carried out in the Department of Obstetrics and Gynaecology, Harran University School of Medicine, and included a total of 1,507 women with histories of recurrent pregnancy loss between January 2010 and June 2013. The mutations were assessed by using the polymerase chain reaction.

Results

The homozygous mutation frequencies of FVL, prothrombin, and MTHFR were found to be 3 (0.20%), 0 and 125 (8.29%), and the heterozygous mutation frequencies were 83 (5.51%), 61 (4.05%), and 612 (40.61%), respectively. Among the 86 FVL mutation patients, 38 also had accompanying prothrombin and MTHFR mutations.

Conclusion

Since the homozygous forms of the FVL-prothrombin gene mutations have low incidences and MTHFR mutation is similar to a healthy population, preconceptional thromogenic gene mutations screening seems to be controversial.

Factor seven activating protease activity levels in women with recurrent pregnancy loss

This study was designed to analyze the changes in circulating factor seven activating protease (FSAP) levels in association with the thrombophilic state of 40 women with recurrent pregnancy loss (RPL). All women were trying to conceive and were prospectively followed up until the achievement of spontaneous pregnancy. The results obtained showed that plasma FSAP activity levels were higher in RPL than in fertile women (P < .001) and represented an adverse predictor of pregnancy at multivariate analysis (P = .002). In 7 consenting RPL women, FSAP activity levels increased continuously during pregnancy until the third trimester, remained elevated immediately after delivery, and declined 6-week postpartum, although at levels that were still above the range of control women. These results suggest that FSAP activity levels might provide useful information during pregnancy progression in at-risk women, possibly acting as a predictive factor for adverse pregnancy outcome in RPL even in the absence of other well recognized thrombophilic conditions.