Association between Blood Immature Platelet fragments and HELLP Syndrome

Abstract

Preeclampsia is defined according to ACOG as hypertension (diastolic blood pressure > 90 mmHg, systolic blood pressure >140 mmHg) based on at least 2 measurements taken at least 4 hours apart and significant proteinuria (Proteinuria >300 mg/24 hours or at least +2 on dipstick. HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome is a variant of severe preeclampsia which is associated with substantial maternal and perinatal morbidity and mortality. As with preeclampsia, the etiology and pathogenesis of HELLP syndrome is not completely understood. An increase in vascular thrombosis and activation of the coagulation system may be important in the clinical presentation of this disorder. The IPF count reflects peripheral PLT destruction that results from the suppression of bone marrow production. Immature platelets contain more RNA than mature PLTs and their number in peripheral blood reflects the rate of thrombopoiesis. The immature PLT fraction (IPF) count is a useful index of thrombopoiesis, which increases when the IPF rises and decreases when the IPF declines. This Study is Case- control Study (Pilot study) was conducted at the department of Obstetrics and Gynecology in Ain Shams University Maternity Hospital on 84 pregnant women after 28 weeks gestation starting from June 2015 and February 2016 to compare the maternal blood level of immature platelet fraction (IPF%) and absolute numbers of IPF in patient initially diagnosed as HELLP syndrome, patient diagnosed as sever preeclampsia and normal pregnant women after 28 weeks of gestational age to determine the possibility to use it as an early marker of platelets recovery after platelets destruction. The candid women of our study are divided into three group, the first group (I) are 28 women pregnant with gestational age after 28 weeks initially diagnosed as HELLP syndrome according to inclusion criteria (Systolic blood pressure ≥ 160 mm Hg or diastolic blood pressure ≥ 110 mm Hg on two occasions at least four hours apart while the patient is on bed rest, Micropathic hemolytic anemia and other signs suggestive of hemolysis include an elevated indirect bilirubin level, Platelet count ≤100,000 cells/microL, Total bilirubin ≥1.2 mg/dL, Serum asparate aminotranseferase> 70 IU/L, Elevated LDH. The second group (II) are 28women pregnant with gastional age after 28weeks diagnosed as severe preeclampsia according to inclusion criteria (Systolic blood pressure ≥ 160 mm Hg or diastolic blood pressure ≥ 110 mm Hg on two occasions at least four hours apart while the patient is on bed rest, Proteinuria ≥ 300 mg/24 h urine collection, Progressive renal insufficiency (serum creatinine >1.1 mg/dL or doubling of serum creatinine concentration in the absence of other renal disease) .The third group (III) (the control group) is 28 normal pregnant women with gestational age after 28 weeks. The current study showed significant negative correlation between platelet count and IPF, and a significant positive correlation between platelet count and A-IPC in included women of the three groups, also there was a significant positive correlation between IPF and PT in women of group with HELLP syndrome. Receiver operator characteristics (ROC) curves were constructed for estimating the association between measured variables and differentiating women with HELLP syndrome from other included women. Platelet count, IPF% and serum AST were, in order, the most significant variables as denoted by their significantly large area under the curves (AUCs). A-IPC