Protein C global assay in the evaluation of women with idiopathic pregnancy loss.
Since the majority of thrombophilic defects in women with pregnancy loss are in the protein C pathway, we have prospectively determined the diagnostic value of a protein C global assay in 60 consecutive women with pregnancy loss compared to 61 controls. Protein C activation time normalized ratio (PCAT-NR) in pregnancy loss women was significantly lower than controls (0.74 +/- 0.16 vs. 0.99 +/- 0.2; P < 0.0001). PCAT-NR lower than cut off level of 0.8 were found in 42/60 (70%) of PL women compared to 7/61 (11%) of controls (OR = 18.0, 95% CI: 6.3-53.4, P < 0.0001). Cut-off level of 0.8 successfully identified all pregnancy loss women with abnormality in the protein C pathway (12 factor V Leiden, 7 APC-Resistance without factor V Leiden, 15 low levels of protein S and 1 of protein C). Moreover, PCAT-NR below 0.8 was documented in 15/29 (52%) of PL women without thrombophilic risk factor compared to 3/55 (5%) of controls (OR = 18.6, 95% CI: 4.2-95.2, P < 0.0001). These results suggest that ProC Global may be useful as a screening test for protein C pathway abnormalities and may serve as a new thrombophilic risk factor in women with pregnancy loss.
Sarig
Galit
G
Thrombosis and Hemostasis Unit, Rambam Medical Center, Haifa, Israel. G_Sarig@rambam.health.gov.il
Lanir
Naomi
N
Hoffman
Ron
R
Brenner
Benjamin
B
D000022:Abortion, Spontaneous / Q000097:blood / Q000209:etiology*; D000328:Adult; D001780:Blood Coagulation Tests / Q000592:standards; D016022:Case-Control Studies; D005260:Female; D005313:Fetal Death / Q000097:blood / Q000209:etiology*; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000175:diagnosis; D011446:Prospective Studies; D011486:Protein C / Q000032:analysis*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D019851:Thrombophilia / Q000150:complications / Q000175:diagnosis
D011486:Protein C