Determination of antiphospholipid antibodies and Thrombophilia in women with recurrent miscarriage

Abstract

Background: Recurrent miscarriage is a critical problem in which many factors play a crucial role such as antiphospholipid antibodies (APA) and anticardiolipin antibodies (ACA). Recent studies pointed to a potential role of thrombophilias as a possible cause of recurrent miscarriage (RM).
Objectives: This study was conducted to determine the frequency of the primary and secondary antiphospholipid syndrome and the haemostatic abnormalities in women with history of RM.
Materials and Methods: This study was a case control study, conducted from Febraury-2008 to February -2011 in Khartoum State. A total of 100 women with three or more consecutive recurrent miscarriage without previous living babies as case group and 100 non complicated pregnant women were screened for the presence of antinuclear antibodies (ANA), anti-double stranded DNA (anti-dsDNA), antiphospholipid antibodies (APA IgM/IgG), and anticardiolipin antibodies (ACA/IgG) by using Enzyme Linked Immuno-Sorbent Assay (ELISA). Patients with history of three miscarriages with delivery of full-term or preterm babies in between or with medical termination of pregnancy were excluded from this study. Women positive for APA were asked for a repeat sample after 6 weeks to run confirmatory test. Patient and control groups were also screened for the count of platelets using Sysmex KXN-21, Activated Partial Thromboplastin Time (APTT), Prothrombin Time (PT) and Thrombin Time (TT) using coagulometer Biobas 10.
Results: The frequencies for both APA and ACA were 20%. ANA and Anti-dsDNA were 12%. There was a significant correlation between age and the presence of APA (P=0.03), ACA (IgG) (P=0.04), ANA and Anti-dsDNA (P=0.013). Frequencies for, thrombocytopenia and lupus anticoagulant (LA) were 8% and 20% respectively. 5% had prolonged PT, whereas the remaining patient and control groups had normal results.
Conclusion: The data concluded that the frequencies of APA, ACA, ANA, Anti-dsDNA, in women with RM obtained in this study were in agreement to the frequencies for these parameters obtained in previous studies and their presence were significantly associated with recurrent miscarriage.
Recommendation: Frequencies of LA and thrombocytopenia were  significantly associated with recurrent miscarriage. Prolongation in PT may be due to the presence of anti-prothrombin antibodies in serum of  patients with recurrent miscarriage. The current study recommends  measuring of APA, ACA, Anti-dsDNA-antibodies and assessment of  platelets count, APTT and PT in all women with recurrent miscarriage and late pregnancy loss.

Keywords: APA, ACA, ANA, Anti-dsDNA, RM, LA, APTT, PT.