Question 22

A 33 yo G2P0 presents for pre-conception counseling. She has a history of a pregnancy loss at 11 weeks after a normal 10 week ultrasound as well as a history of a 16 week pregnancy loss in a fetus with trisomy 13. You notice that she tested positive for anti-beta2-glycoprotein IgG 4 months ago and again last week. She has no history of thrombosis. Her mother had venous thromboembolism at age 65. The clinical history that supports the diagnosis of antiphospholipid syndrome in this patient is:

Answer Choices:

A family history of vascular thrombosis

Fetal loss at 11 weeks

Fetal loss at 16 weeks

Two consecutive fetal losses

Correct Answer:

Fetal loss at 11 weeks

Explanation:

  • The clinically relevant antiphospholipid antibodies are lupus anticoagulant, anticardiolipin, and anti-beta2-glycoprotein I.

  • Abnormal labs must be confirmed at least 12 weeks after the initial test because transient positives can occur

  • This patient has met the laboratory criteria for antiphospholipid syndrome

  • She requires a clinical criteria to confirm the diagnosis: potential clinical criteria include history of arterial or venous thrombosis, history of one or more unexplained death of a morphologically normal fetus at or beyond 10 weeks (need a normal ultrasound or direct exam of fetus), one or more deliveries of a morphologically normal neonate prior to 34 weeks due to preeclampsia or placental insufficiency or 3 or more unexplained consecutive spontaneous pregnancy losses prior to 10 weeks (excluding anatomic, hormonal or genetic causes)

  • Patients with this diagnosis have a 5-12% risk of thrombosis in pregnancy so anticoagulation should be considered