title: Elevated Factor VIII Levels and Shortened APTT in Recurrent Abortions.
abstract: BACKGROUND
  Thrombotic disorders have been found to be associated with recurrent abortions. Several risk factors have been identified. APTT reflects the common pathway and intrinsic pathway of coagulation cascade and hence is a good marker for thrombotic work. Elevated factor VIII: C has also been identified as risk factor for recurrent miscarriage. This study aims at identifying association of elevated factor VIII levels, shortened APTT and recurrent abortions in Indian population as little has been studied about this and the literature available is also based on studies done in European population. This study also aims to find whether shortened APTT can be an independent risk as well.
  
  
  METHODS
  Women referred to the obstetrics department with a history of early recurrent early pregnancy loss (at least three pregnancy losses before 13 weeks of gestation) were included in this study. Exclusion criteria were elevated CRP levels, positive antiphospholipid antibodies, endocrine, immunological or anatomical cause of embryo demise. A total of 68 cases of recurrent abortion were included in this study, 68 normal pregnant females (<15 weeks of gestation) were also included as controls with no history of abortion. The age group of the cases as well as control was 20-45 years. Activated partial thromboplastin time and factor VIII assay (one stage APTT based) were done on the blood samples.
  
  
  RESULTS
  Increased factor VIII levels were seen in 25 cases (36.4%); 19 cases showed shortened APTT (27.3%); 12 cases showed both increased factor VIII levels as well as shortened APTT (18%). All risk factors were negative in 36 cases (52.9%). None of the controls showed elevated factor VIII levels or shortened APTT. The mean APTT values of the control subjects was 31.01 and cases were 27.01 (p=0.001). The mean factor VIII levels of case were 152.85% and control 144.953% (p=0.012).
  
  
  CONCLUSIONS
  There was significant association between recurrent abortions and elevated factor VIII :c levels and shortened APTT. Shortened APTT was also identified as an independent risk factor.
authors.affiliation: Associate Professor, Department of Pathology, Karuna Medical College , Palakkad, Kerala, India .
authors.forename: Aysha
authors.initials: A
authors.lastname: Ali
authors.affiliation: Professor, Department of Pathology, Karuna Medical College , Palakkad, Kerala, India .
authors.forename: Pushpavalli
authors.initials: P
authors.lastname: Mohan
authors.affiliation: Resident, Department of Pathology, Karuna Medical College , Palakkad, Kerala, India .
authors.forename: Hana
authors.initials: H
authors.lastname: Kareem
authors.affiliation: Resident, Department of Pathology, Karuna Medical College , Palakkad, Kerala, India .
authors.forename: Mahsheena Kalpaka
authors.initials: MK
authors.lastname: Muhammed
keywords: Coagulation studies; One stage factor viii assay; Pregnancy; Thrombosis