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Fu M, Liu J, Xing J, Dai Y, Ding Y, Dong K, Zhang X, Yuan E. Reference intervals for coagulation parameters in non-pregnant and pregnant women. Sci Rep 2022; 12:1519. [PMID: 35087162 PMCID: PMC8795382 DOI: 10.1038/s41598-022-05429-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 01/11/2022] [Indexed: 12/19/2022] Open
Abstract
Established reference intervals (RIs) of coagulation parameters generally based on the general population are not applicable to specific women. In order to accurately evaluate the coagulation status of non-pregnant women and pregnant women, specific RIs should be established. Our study recruited 465 non-pregnant women and 1972 pregnant women aged 20-45 years. Eight tests including antithrombin (AT), protein C (PC), free protein S (fPS), lupus anticoagulant (LA), D-dimer, fibrin/fibrinogen degradation products (FDP), coagulation factor VII (FVII), and factor VIII (FVIII) were performed on ACL TOP automated coagulation instrument. The RIs for these tests were established in non-pregnant and pregnant women at different gestational weeks. Compared to the non-pregnant group, the medians of AT and fPS were lower, while the medians of PC, LA normalized ratio, D-dimer, FDP, FVII, and FVIII were higher. During pregnancy, AT and fPS activity showed a decreasing trend, with the increase of gestational age. PC activity, LA normalized ratio, D-dimer concentrations, FDP concentrations, FVII, and FVIII activity presented an increasing trend, with the increase of gestational age. The non-pregnant women-specific RIs and the gestational age-specific RIs of AT, PC, fPS, LA normalized ratio, D-dimer, FDP, FVII, and FVIII needed to be established for accurate clinical diagnoses.
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Affiliation(s)
- Mengyu Fu
- Department of Clinical Laboratory, the Third Affiliated Hospital of Zhengzhou University, No.7 Front Kangfu Street, Er'qi District, Zhengzhou, 450052, China
| | - Junjie Liu
- Henan Human Sperm Bank, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Jinfang Xing
- Department of Clinical Laboratory, the Third Affiliated Hospital of Zhengzhou University, No.7 Front Kangfu Street, Er'qi District, Zhengzhou, 450052, China
| | - Yanpeng Dai
- Department of Clinical Laboratory, the Third Affiliated Hospital of Zhengzhou University, No.7 Front Kangfu Street, Er'qi District, Zhengzhou, 450052, China
| | - Yanzi Ding
- Department of Clinical Laboratory, the Third Affiliated Hospital of Zhengzhou University, No.7 Front Kangfu Street, Er'qi District, Zhengzhou, 450052, China
| | - Kainan Dong
- Department of Clinical Laboratory, the Third Affiliated Hospital of Zhengzhou University, No.7 Front Kangfu Street, Er'qi District, Zhengzhou, 450052, China
| | - Xuewei Zhang
- Department of Clinical Laboratory, the Third Affiliated Hospital of Zhengzhou University, No.7 Front Kangfu Street, Er'qi District, Zhengzhou, 450052, China
| | - Enwu Yuan
- Department of Clinical Laboratory, the Third Affiliated Hospital of Zhengzhou University, No.7 Front Kangfu Street, Er'qi District, Zhengzhou, 450052, China.
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Kamamoto T, Nakajima Y, Uchida Y, Nakagawa T, Tonegawa H, Tani Y, Nishimoto E, Takahashi Y, Nishikubo T, Nogami K. Protein C system in preterm babies with chronic lung disease: Prospective study. Pediatr Int 2022; 64:e15221. [PMID: 35912452 DOI: 10.1111/ped.15221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/09/2022] [Accepted: 04/15/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Chronic lung disease (CLD) is a major neonatal pulmonary disorder associated with inflammation. Recent studies have shown that protein C anticoagulant pathways, such as those for protein C (PC), protein S (PS), and thrombomodulin (TM), could be useful indices for reflecting pulmonary injury. However, the involvement of these factors in preterm infants with very low birthweight (VLBW) who have developed CLD remains to be investigated. Here, we investigated whether PC pathway-related factors could predict the development of CLD in preterm infants with VLBW. METHODS We collected plasma samples from 26 preterm infants with VLBW (13 each from those with and without CLD) at the time of birth and measured TM, PC, and PS levels in their plasmas. We analyzed prospectively the relationship between these factors in infants with and without CLD. RESULTS There were significant differences in gestational age, birthweight, Apgar score (5 min), and duration of mechanical ventilation between the CLD and non-CLD groups. No significant differences in the PC and PS levels at birth were observed between the two groups, whereas the TM levels in the CLD group were significantly higher than those in the non-CLD group (P = 0.013). The TM levels correlated with gestational age and duration of mechanical ventilation. However, covariance analysis demonstrated that gestational age was significantly associated with TM levels, and consequently, development of CLD was not associated with TM level at birth. CONCLUSIONS Thrombomodulin, PC, and PS levels at birth could not predict the development of CLD in preterm infants with VLBW.
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Affiliation(s)
- Tomoyuki Kamamoto
- Division of Neonatal Intensive Care, Center of Perinatal Medicine, Nara Medical University Hospital, Kashihara, Nara, Japan
| | - Yuto Nakajima
- Department of Pediatrics, Nara Medical University, Kashihara, Nara, Japan.,Advanced Medical Science of Thrombosis and Hemostasis, Nara Medical University, Kashihara, Nara, Japan
| | - Yumiko Uchida
- Division of Neonatal Intensive Care, Center of Perinatal Medicine, Nara Medical University Hospital, Kashihara, Nara, Japan
| | - Takashi Nakagawa
- Division of Neonatal Intensive Care, Center of Perinatal Medicine, Nara Medical University Hospital, Kashihara, Nara, Japan
| | - Hitoshi Tonegawa
- Division of Neonatal Intensive Care, Center of Perinatal Medicine, Nara Medical University Hospital, Kashihara, Nara, Japan
| | - Yuki Tani
- Division of Neonatal Intensive Care, Center of Perinatal Medicine, Nara Medical University Hospital, Kashihara, Nara, Japan
| | - Eri Nishimoto
- Division of Neonatal Intensive Care, Center of Perinatal Medicine, Nara Medical University Hospital, Kashihara, Nara, Japan
| | | | - Toshiya Nishikubo
- Division of Neonatal Intensive Care, Center of Perinatal Medicine, Nara Medical University Hospital, Kashihara, Nara, Japan
| | - Keiji Nogami
- Department of Pediatrics, Nara Medical University, Kashihara, Nara, Japan
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Yoshida S, Miyakoshi A, Arai D, Kawanabe Y, Sato T. A Case of an Early Pregnant Woman with Congenital Protein S Deficiency Who Underwent Mechanical Thrombectomy. JOURNAL OF NEUROENDOVASCULAR THERAPY 2021; 16:204-210. [PMID: 37502450 PMCID: PMC10370991 DOI: 10.5797/jnet.cr.2020-0178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 07/04/2021] [Indexed: 07/29/2023]
Abstract
Objective Large vessel occlusion (LVO) stroke during pregnancy is rare but a life-threatening issue for the mother and fetus. We report a rare case of a pregnant woman with congenital protein S deficiency who underwent mechanical thrombectomy. Case Presentation A 35-year-old woman presented with right hemiplegia and aphasia. The National Institutes of Health Stroke Scale was 23 and MRI revealed acute infarction on the left hemisphere. MRA showed disruption of the left middle cerebral artery. Mechanical thrombectomy was performed following intravenous thrombolysis, and then complete recanalization was achieved. The reduction in protein S activity due to pregnancy was suspected to have affected LVO. Subsequently, the patient was diagnosed with congenital protein S deficiency and recovered to modified Rankin scale 2 at 3 months after the onset. Conclusion Aggravation of congenital protein S deficiency due to pregnancy led to the onset of LVO. The patient showed a good outcome after mechanical thrombectomy.
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Affiliation(s)
- Shota Yoshida
- Department of Neurosurgery, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
| | - Akinori Miyakoshi
- Department of Neurosurgery, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
| | - Daisuke Arai
- Department of Neurosurgery, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
| | - Yoshifumi Kawanabe
- Department of Neurosurgery, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
| | - Tsukasa Sato
- Department of Neurosurgery, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
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Giller A, Andrawus M, Gutman D, Atzmon G. Pregnancy as a model for aging. Ageing Res Rev 2020; 62:101093. [PMID: 32502628 DOI: 10.1016/j.arr.2020.101093] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 04/21/2020] [Accepted: 05/23/2020] [Indexed: 12/12/2022]
Abstract
The process of aging can be defined as the sum accumulation of damages and changes in metabolism during the life of an organism, due to both genetic predisposition and stochastic damage. During the gestational period and following parturition, similar damage can be seen due to the strenuous effect on the maternal body, exhibited on both the physiological and cellular level. In this review, we will focus on the similar physiological and cellular characteristics exhibited during pregnancy and aging, including induction of and response to oxidative stress, inflammation, and degradation of telomeres. We will evaluate any similar processes between aging and pregnancy by comparing common biomarkers, pathologies, and genetic and epigenetic effects, to establish the pregnant body as a model for aging. This review will approach the connection both in respect to current theories on aging as a byproduct of natural selection, and regarding unrelated biochemical similarities between the two, drawing on existing studies and models in humans and other species where relevant alike. Furthermore, we will show the response of the pregnant body to these changes, and through that illuminate unique areas of potential study to advance our knowledge of the maladies relating to aging and pregnancy, and an avenue for solutions.
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Affiliation(s)
- Abram Giller
- Faculty of Natural Sciences, University of Haifa, 199 Aba Khoushy Ave., Mount Carmel, Haifa, 349888, Israel
| | - Mariana Andrawus
- Faculty of Natural Sciences, University of Haifa, 199 Aba Khoushy Ave., Mount Carmel, Haifa, 349888, Israel
| | - Danielle Gutman
- Faculty of Natural Sciences, University of Haifa, 199 Aba Khoushy Ave., Mount Carmel, Haifa, 349888, Israel
| | - Gil Atzmon
- Faculty of Natural Sciences, University of Haifa, 199 Aba Khoushy Ave., Mount Carmel, Haifa, 349888, Israel; Departments of Genetics and Medicine, Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, New York, 10461, USA.
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Bagot CN, Leishman E, Onyiaodike CC, Jordan F, Gibson VB, Freeman DJ. Changes in laboratory markers of thrombotic risk early in the first trimester of pregnancy may be linked to an increase in estradiol and progesterone. Thromb Res 2019; 178:47-53. [PMID: 30965151 DOI: 10.1016/j.thromres.2019.03.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 03/19/2019] [Accepted: 03/21/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Pregnant women are at increased risk of venous thrombosis compared to non-pregnant women. Epidemiological and laboratory data suggest that hypercoagulability begins in the first trimester but it is unknown exactly how early in pregnancy this develops. The mechanisms that result in a prothrombotic state may involve oestrogens and progestogens. METHODS Plasma samples were taken prior to conception and five times in early pregnancy, up to Day 59 gestation, from 22 women undergoing natural cycle in vitro fertilization, who subsequently gave birth at term following a normal pregnancy. Thrombin generation, free Protein S, Ddimer, Fibrinogen, factor VIII, estradiol and progesterone were measured. To counter inter-individual variability, the change in laboratory measurements between the pre-pregnant and pregnant state were measured over time. RESULTS Peak thrombin, Endogenous Thrombin Potential, Velocity Index and fibrinogen significantly increased, and free Protein S significantly decreased, from pre-pregnancy levels, by 32 days gestation. Ddimer and VIII significantly increased from pre-pregnancy levels by 59 days gestation. Estradiol significantly increased by Day 32 gestation with a non-significant increase of 67% by Day 24 gestation. Progesterone significantly increased by Day 32 gestation. Almost all laboratory markers of thrombosis correlated significantly with estradiol and progesterone. CONCLUSION Our work is the first to demonstrate that the prothrombotic state develops very early in the first trimester. Laboratory markers of hypercoagulability correlate significantly with estradiol and progesterone suggesting these are linked to the prothrombotic state of pregnancy. Clinicians should consider commencing thromboprophylaxis early in the first trimester in women at high thrombotic risk.
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Affiliation(s)
- C N Bagot
- Department of Haematology, Glasgow Royal Infirmary, Glasgow, UK.
| | - E Leishman
- Department of Haematology, Glasgow Royal Infirmary, Glasgow, UK
| | - C C Onyiaodike
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - F Jordan
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - V B Gibson
- Department of Haematology, Glasgow Royal Infirmary, Glasgow, UK
| | - D J Freeman
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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Bagot C, Leishman E, Onyiaodike C, Jordan F, Freeman D. Normal pregnancy is associated with an increase in thrombin generation from the very early stages of the first trimester. Thromb Res 2017; 157:49-54. [DOI: 10.1016/j.thromres.2017.06.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 05/23/2017] [Accepted: 06/22/2017] [Indexed: 11/27/2022]
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