Association between non-O blood group and spontaneous abortion in women with inherited thrombophilia

Background

Spontaneous abortion is reported to be one of the most frequent pregnancy complications reaching a prevalence up to 15%. The association between congenital thrombophilia and pregnancy loss has been debated in several studies with conflicting results. We aimed to retrospectively evaluate the prevalence of inherited thrombophilia (i.e antithrombin, protein S and C deficiencies, factor V Leiden and prothrombin variant) in a group of women with a personal history of miscarriage. The prevalence non-O blood group, considered the most common thrombophilic condition, was concomitantly considered.

Materials and methods

A group of n. 566 women with a personal history of spontaneous abortion recruited among caregivers of patients admitted to the Medical Department of our University Hospital between December 2011 and December 2019 were enrolled. Women under 18 yrs, those with a personal history of venous and/or arterial thrombosis and with an acquired thrombophilic condition were excluded. An equally number of healthy women without a personal history of pregnancy loss acted as controls. The Odds Ratios (ORs) and 95% confidence intervals (CIs) were calculated as an estimate of pregnancy loss developing.

Results

Out of n. 566 enrolled women, n. 127 (22.4%) had an inherited thrombophilic condition. The prevalence of congenital thrombophilia was significantly higher in women with miscarriage than controls (OR 2.12; CI 95% 1.51–2.92). Non-O blood type was observed in n. 325 (57.4%) women. The prevalence of non-O blood group was significantly higher in women with pregnancy loss (p 0.01) and the association of thrombophilia and non-O blood type further increased the risk of pregnancy loss (OR 3.28; CI 95% 2.01–5.36).

Conclusions

Both inherited thrombophilia and non-O blood type should be considered risk factors for pregnancy loss. The knowledge of this information may help the clinician to better manage women with pregnancy loss. Further studies are required to confirm our findings.

Funding Acknowledgement

Type of funding sources: None.

The haemostatic system in acromegaly: a single-centre case-control study

PURPOSE

Although the mortality from acromegaly is due in most cases to an increased cardiovascular risk, no study has globally evaluated the haemostatic balance in acromegaly to ascertain the presence of hypercoagulability. We endeavoured to assess the overall coagulation profile in patients with acromegaly using both traditional and global coagulation assays.

METHODS

Consecutive outpatients with a diagnosis of acromegaly were enrolled and matched with healthy subjects. Whole blood thromboelastometry and impedance aggregometry, procoagulant, anticoagulant and fibrinolytic factors, as well as thrombin-generation assay and circulating endothelium-derived microvesicles were measured.

RESULTS

Forty patients (M/F 14/26, median age 59 years) with either new diagnosis (naïve, 14 cases) or treated acromegaly (26 cases) were enrolled in this study. Median time from diagnosis was 11 years. Levels of factor VIII and fibrinogen were significantly higher in acromegalic patients vs. controls (p = 0.029 and < 0.003, respectively). Overall, thromboelastometry parameters showed a faster coagulation formation with a more stable clot. Acromegaly patients showed significantly higher endogenous thrombin potential [ETP] and thrombin peak compared to controls (p = 0.016 and p < 0.001, respectively). ETP remained significantly higher (p < 0.001) when thrombomodulin was added. Endothelial-derived microvesicles were significantly higher in acromegaly patients than controls (52 [40.5-67] MVs/µL and 30 [18-80] MVs/µL, p = 0.03). Patients with untreated (naïve) acromegaly showed significantly reduced ETP with and without thrombomodulin vs. patients with treated acromegaly (p = 0.01).

CONCLUSION

Hypercoagulability in acromegaly is mainly due to higher levels of fibrinogen, factor VIII and thrombin generation, and appears to be more linked to the chronic phase of the disease.