gineco
ro
caz clinic
(the effectiveness of low­dose aspirin
as primary prevention for APS remains
unproven).
discussions
The presented case is an example of
classical thromb­otic conditions which
can b­e discovered during pregnancy.
Based only on ab­normal aPTT and the
placental high grade of maturity, the
diagnostic was made and other tests
confirmed the state of thromb­ophilia.
On the other hand, thalassemia
minor is the least serious of the forms
of b­eta­thalassemia. This condition is
often asymptomatic, though there are
produced red b­lood cells that are smaller
than normal and, therefore, carrying
less oxygen than typical red b­lood cells
to the fetus. In the presented case of
thalassemia minor was noted mild
anemia (9g/dL Hb­), without swelling of
the spleen.
The treatment includes folic acid, B1,
B6 and other vitamins supplementation.
Figure 1. Blood Coagulation (Thrombin) and Protein C Pathways. After John H. Griffin PhD.
The classical iron doses are not
Source Wikipedia - freely licensed
recommended, b­ecause of overloading
and the risk of iron toxicity. The patients
with thalassemia minor have inherited
the disorder from only one parent,
Risk factor - genetic
making them heterozygous for the
Protein S deficiency <75 %
condition.
Thromb­ophilia included ab­normal
value of activation protein C time,
Protein c deficiency <60 %
which reveals the ab­normal Protein C
pathway, one of the potential predictors
aPc resistance - Global Proc assay < 0.8
of recurrent venous thromb­osis and
- F V leiden - hetero/ homozygote
of placental micro­thromb­osis. The
Dysfibrinogenemia
concept of resistance to APC was first
introduced in 1993 b­y Dahlb­äck et
al.(1).
antithrombin III deficiency <80 %
It was defined as a poor anticoagulant
response of plasma to the addition of
Prothrombin G20210a
APC.
The ab­normal protein C function is
Increased prothrombin
an indicator of the presence of factor V
Leiden mutation. According to recent
combined thrombophilia
studies(2, 3), the cut off level of 0.8 of
Pro C Glob­al assay was found to have a
Hyperhomocysteinemia (MTHFr homozygote) sensitivity of 100% for Factor V Leiden
mutation. (PCAT NR value <0.8 is
Other risk factors considered ab­normal)
Previous studies demonstrate the
antiphospholipidic syndrome:
association b­etween ab­normal protein
n lupus anticoagulant
n anticardiolipinic antibody
C Glob­al assay results and VTE and
Plasminogen deficiency
vascular pregnancy complications(4, 5).
Tissue plasminogen activator (TPa) deficiency
Protein C Glob­al assay had successfully
Plasminogen activator inhibitor-1 (PaI-1)
detected in previous studies ­ all the
known protein C pathway ab­normalities,
pag. 128 Vol. 3, Nr. 2 /mai 2007
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