FRCPath Haem Part 1 MCQs-Haemostasis 499

A 32-year-old woman is referred to the haematology clinic at 7 weeks of gestation in her fourth pregnancy. She has no personal history of venous or arterial thrombosis and has never received anticoagulation.

Her obstetric history includes:

• Pregnancy 1: Uncomplicated term delivery.

• Pregnancy 2: Spontaneous miscarriage at 8 weeks.

• Pregnancy 3: Uncomplicated term delivery.

  
  

During preconception investigations, she was found to have a positive lupus anticoagulant (LA) and moderately elevated IgG anticardiolipin antibodies. Repeat testing 14 weeks later confirmed persistent positivity. Anti-β₂-glycoprotein I antibodies are negative.

She has no clinical features of systemic lupus erythematosus. Her platelet count is 218 x 10^9/L, renal function is normal, and she has no bleeding history. She is currently taking folic acid but no antithrombotic medication.

Which is the single best approach to antithrombotic management at this stage of pregnancy?

A.     Start low-dose aspirin from the positive pregnancy test

B.     Start low-dose aspirin and prophylactic LMWH immediately

C.     Start therapeutic-dose LMWH

D.     Withhold aspirin and LMWH until 12 weeks of gestation, when placental-mediated complications become clinically relevant.

E.      Start hydroxychloroquine and therapeutic-dose LMWH because she has persistent positivity for two aPL tests.