Recurrent miscarriage and blood disorders: Integrating haematology into reproductive care

Antiphospholipid syndrome (APS) and inherited thrombophilia are well-recognized haematological causes of recurrent miscarriages. APS is an acquired autoimmune disorder linked to both early and late pregnancy losses. A meta-analysis of 120 studies reported that antiphospholipid antibodies are present in about 6% of women with pregnancy complications. Diagnosis of APS requires at least one clinical criterion plus one or more laboratory criteria. Clinical criteria include venous, arterial or microvascular thrombosis or pregnancy morbidity while laboratory criteria include positive lupus anticoagulant (LAC), or moderate-to-strong positivity for anti-cardiolipin IgM/IgG or anti-β2 glycoprotein I IgM/ IgG antibodies. Women with obstetric or thrombotic APS should be managed jointly in haematology-obstetric clinics. Treatment with low-dose aspirin and heparin is the standard therapeutic approach. This combination improves live birth rates by preventing clot formation, enhancing placental function and reducing risks such as pre-eclampsia and fetal growth restriction. Inherited thrombo-philias such as factor V Leiden, prothrombin gene mutation, protein S deficiency and antithrombin deficiency have been found to be associated with recurrent miscarriages.