Hematologist or MFM for pre-conception consult on clotting issues?

[Anonymous]

I already know my genetic profile in terms of the major clotting-related mutations, having been tested due to family history. However, that was several years back, and I think there has been a lot more work since then on the implications of the various mutations and the appropriate treatments for women trying to get and stay pregnant. I'd like a consult but I'm not sure if I should be looking at hematologists or MFMs. Any recommendations for specific doctors specialized in the reproductive implications of clotting-related mutations? Downtown DC or MoCo, preferably.

[Anonymous]

Hi - I tested positive for a double MTHFR mutation when pregnant with #2 (I had lots of testing done after the extremely challenging birth of my first). I switched to the GW practice (MFA). My primary doctor, Charles Macri, is an MFM, and I saw a hematologist, Khaled El-Shami, there throughout my pregnancy. Although I was extremely low-risk for clotting, they suggested treating me with Lovenox throughout the pregancy, and monitored by homocysteine levels throughout.

What I like best about the practice is that all of the doctors are located in the same medical building, and they work with you to layer appointments. I was also doing non-stress tests for the last 8 weeks, and I could do all of those in-house as well.

[Anonymous]

Do you clot too fast or not fast enough?

I don't have enough of a clotting factor (also a genetic condition) and so I don't clot quick enough. I am currently monitored by a hematologist at WHC, Dr. Vera Malkovska, in conjunction with my OB at WHC. Again: all located in the same building and all information is shared through electronic records. Both will monitor my delivery as they did with my first a few years ago.

I strongly recommend Malkovska and her team. Very smart.

[Anonymous]

Dr. Hamersley in Rockville is probably your best bet. She has FVL and has had miscarriages related to her clotting disorder. I saw her after many losses as well and she was the only one willing to put me on lovenox while TTC. It wasn't the miracle I needed but it certainly helped. She is an MFM, but knows a lot about clotting disorders in pregnancy. It's imperative to work with someone who knows what they are doing IMO.

I have FVL also, MTHFR, PAI-1, and had some high and borderline APS values.