Click here for episode 1
Irene’s testing came back with a positive result, for a test called Lupus Anti-Coagulant (LAC). Instead of being depressed about having something abnormal, she was actually happy, especially when she learned that there was a way to address this problem.
The name, Lupus Anticoagulant, is paradoxically misleading. Most women with Lupus don’t have a positive LAC. Most women with a positive LAC don’t have lupus. Furthermore, it’s not truly an anti-coagulant. In fact, the miscarriage issues stem from it being a PRO-coagulant, meaning it causes excessive blood clotting. One way to think of this is that Irene’s immune system is overachieving. Instead of merely attacking germs and foreign substance invaders to her body, the immune system is also attacking her own cells, leading to unpredictable outcomes, one of which is recurrent pregnancy loss. The important thing to remember is this. Patient with a history of recurrent miscarriage and a positive LAC would most likely benefit from some form of true anticoagulation.
With a focus on the practical implications, we now had a plan. The next time Irene got pregnant, we would give her something to counteract the harmful effects of the positive LAC.
Irene now had the following concrete game plan. She would call us as soon as she missed a period and come in for a pregnancy test. If it was positive, then we would put her on heparin, a blood thinner. We had to also have a backup plan. In case she wasn’t pregnant within six months, we would re-evaluate to see if she would like us to do something to speed things up.
Click here for episode 6
