Alpha II Antiplasmin Deficiency Complicating Pregnancy: A Case Report

Abstract

Background. Alpha II antiplasmin is a protein involved in the inhibition of fibrinolysis. A deficiency in this protein leads to increased hemorrhage. It is inherited in an autosomal recessive fashion. Case. 30-year-old Gravida 1, Para 0, presented for prenatal care with her first and subsequently her second pregnancy. Her medical history was significant for a known deficiency in alpha II antiplasmin. Her first and second pregnancies were complicated by nonobstetrical hemorrhage requiring transfusions and severe preeclampsia requiring preterm deliveries. Conclusion. Alpha II antiplasmin deficiency resulted in multiple episodes of nonobstetrical hemorrhages requiring transfusion and ultimately preterm deliveries due to severe preeclampsia. Both infants and mother had a good outcome. The presence of this disorder may require a multidisciplinary team approach involving obstetricians, pediatricians, and hematologists. Precis. Alpha II antiplasmin deficiency is a rare autosomal recessive disorder leading to increased fibrinolysis and hemorrhage. We present a case report of a pregnancy complicated by this disorder.

Hemorrhagic disorders of fibrinolysis: a clinical review

“…The most common bleeding symptoms in individuals with a heterozygous α2‐AP deficiency were post‐surgery and post‐traumatic. Although the occurrence of menorrhagia and postpartum bleeding could not be calculated, because many articles do not give details on whether participants were male or female, these symptoms appear to occur quite often as well . All of the heterozygous individuals had α2‐AP levels of around 50%.…”

“…It is unknown whether women with a heterozygous α2‐AP deficiency experience high rates of obstetric complications, as almost no adult women with pregnancies have been described. There are some reports of relevant obstetric bleeding complications in both homozygous and two heterozygous women, leading to miscarriage and preterm delivery . In summary, homozygous α2‐AP deficiency is associated with a severe bleeding tendency and possibly a high rate of female‐specific bleeding problems.…”

“…A total of 104 individuals with a heterozygous a2-AP deficiency were found. These individuals either had bleeding symptoms or were family members of a known homozygous patient [17,19,20,24,[26][27][28][29][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45]. Sixty-six of 104 heterozygous individuals were asymptomatic.…”