A 26-Year-Old Woman, Gravida 2 Para 1, at 8 Weeks

A 26-year-old woman, gravida 2 para 1, at 8 weeks gestation comes to the office due to pain and swelling of her left leg for the past day.  The patient had a pulmonary embolism during her previous pregnancy, and prophylactic low-molecular-weight heparin therapy was initiated 6 days ago.  She has no other medical conditions and takes prenatal vitamins.  Physical examination shows left lower extremity edema and calf tenderness but no other abnormalities.  Venous duplex ultrasonography reveals acute left femoral vein thrombosis.  Platelet count, which was normal prior to anticoagulant therapy initiation, is 84,000/mm³.  Other blood cell counts and renal and liver function studies are within normal limits.  Which of the following most likely predisposed this patient to her current condition?

A) Acquired protein C deficiency
B) Anti-platelet factor 4/heparin antibodies
C) Anti-platelet glycoprotein IIb/IIIa antibodies
D) Cold-precipitable immunoglobulins
E) Decreased ADAMTS13 level

Correct Answer:

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