High Risk

I had my appointment with the Hemotologist on Tuesday, and while he didn't really tell me anything I didn't already know, he gave me some further information on what I already knew. Basically, I have this inherited abnormality in the Factor V Leiden gene, which increases my likliness of clotting. Duh. He said that with my structural abnormality (extra rib), clotting abnormality, and being on the pill, I was basically a ticking time bomb. I will always be at risk, always. I will be at particular risk whenever I fly anywhere longer than 6 hours, and with any hormone change, such as pregnancy. Actually this pregnancy thing is quite serious. Here is what I've found:





Women with Factor V Leiden (FVL) have a substantially increased risk of
clotting in pregnancy (and on estrogen containing birth control pills or
hormone replacement) in the form of DVT (deep vein thrombosis, sometimes
known as "milk leg") and pulmonary embolism. They also have an increased
risk of preeclampsia, as well as miscarriage and stillbirth due to clotting
in the placenta, umbilical cord, or the fetus (fetal clotting may depend on
whether the baby has inherited the gene). Note that many, many of these
women go through one or more pregnancies with no difficulties, while others
may miscarry over and over again, and still others may develop clots within
weeks of becoming pregnant.

There may be nutritional and lifestyle reasons why some women clot and some
women don't. There is some evidence that low magnesium levels can increase
the tendency to clot (2). Likewise, high homocysteine levels may magnify
the effects of FVL or vice versa. The treatment for high homocysteine
levels is supplementation of vitamins B-6, B-12, and folic acid (3). Both
birth control pills and pregnancy demand higher intake of these nutrients,
so nutritional deficiencies in women with FVL can have extreme
consequences. Likewise, women who exercise regularly and are not immobile
for long periods of time will have better circulation and less opportunity
for clots to form. Given that the vast majority of people with FVL are
unaware of the condition, and the fact that in the U.S. it is a safe bet
that every midwife has had at least one and probably many clients with FVL,
it pays to be aware both of the nutritional issues and the symptoms of
abnormal clotting.

Women who are diagnosed with FVL are generally considered high risk in
pregnancy, particularly if they have had clotting in the past. Standard
medical practice in most cases is prophylactic treatment with low-dose Low
Molecular Weight Heparin (LMWH, usually Lovenox) for women who are not
actively clotting and therapeutic anticoagulation with LMWH for women with
active clotting.





So, further investigation will be done, since a 'slight abnormality' has shown up in another clotting factor, along with the 'significant abnormality' with the Factor V Leiden. And some family testing may be done to figure out if anyone else has inherited this condition, and where the heck it came from. Life goes on.