Recurrent Pregnancy Loss in a 33-Year-Old Woman

### Patient: A 33-year-old pregnant woman of Asian-Indian descent. ### Chief Complaint: History of recurrent miscarriages (G4, P1, A2). The patient presents at 15 weeks gestation in her fourth pregnancy for antenatal care. ### History: Her first and third pregnancies ended with first trimester (less than 12 weeks gestational age) miscarriages of unknown cause. The second pregnancy was complicated by pregnancy-induced hypertension (PIH) and was successfully carried to term, with a living boy delivered by Cesarean section at 40 weeks gestation. The newborn boy was healthy, but was small (2300 gm) for gestational age. The patient had never been transfused blood products. The patient had a history of mild asthma and remote uneventful tonsillectomy. There was no significant family history. ### Physical Exam Findings: Physical examination was normal for gestational age. Initial Laboratory Findings: CBC, routine coagulation testing, type and screen, and thrombophilia workup were performed on the mother, at 15 weeks gestation (Table 1). Additional Laboratory Testing: Additional blood bank testing was performed on the mother (Tables 2, 3, and 4) and on family members (Table 5). 1. What are the patient’s most striking initial clinical laboratory findings? 2. What is the clinical significance in pregnancy of the abnormal thrombophilia test result? 3. What do the additional blood bank investigations demonstrate? 4. What is the nature of the red cell antibody? 5. What is the clinical significance of the red cell antibody for the patient? 6. What is this patient’s chance to get compatible red blood cell (RBC) units if blood transfusion is urgently required, and what are other possible alternatives if no compatible blood is accessible? 7. Does the maternal alloantibody in this case have any effect on the newborn baby and why? 1. The most striking laboratory findings include the positive RBC antibody screening test and the presence of heterozygosity for Factor V Leiden mutation. 2. The patient was shown to be …