Leucocyte count and leucocyte differential in smoking and non-smoking females during pregnancy

Pregnancy-induced leukocytosis: A case report

BACKGROUND

Pregnancy is a complex physiological process. Physiological leukocytosis occurs often and is mainly associated with increased neutrophil counts, especially in the third trimester of pregnancy. Non-congenital leukocytosis with white blood cell counts above 20 × 10⁹/L lasting 13 wk during pregnancy is rare and has been reported occasionally. Herein, we present a case of pregnancy-induced leukocytosis.

CASE SUMMARY

We present the case of a 33-year-old Chinese woman at 27 wk of gestation who had a leukocytosis complication. No abnormalities were detected in the examinations before pregnancy or in the first trimester. From the third trimester of pregnancy, the patient began to suffer from asymptomatic leukocytosis. We administered antibiotics to treat the patient; however, the complication persisted until the patient underwent a cesarean section after 40⁺³ wk of gestation. One day after the cesarean section, the patient’s neutrophil count returned to normal. After 2 years of follow-up, we found that the patient and baby were healthy.

CONCLUSION

Pregnancy-induced leukocytosis seems to be associated with immunoregulation and pregnancy termination may be the most effective treatment approach for pregnancies complicated with malignant leukocytosis.

The effect of labor and delivery on white blood cell count

OBJECTIVE

To explore post-partum white blood cell (WBC) count, and possible factors affecting it.

STUDY DESIGN

Retrospective cohort analysis of 12 079 healthy women, delivering a singleton term fetus with an uncomplicated course of labor, delivery and puerperium. All women delivered in a single tertiary, university-affiliated medical center from 2009 to 2014. Student's t-test, Mann-Whitney's U-test, χ(2) test and ANOVA were used to compare between variables. Multiple variable analyses was performed to allow adjustment for potential covariates and confounders. The main outcome measures included post-partum WBC count and the difference in the post-partum versus ante-partum WBC count, in association to mode of delivery, type of analgesia, timing of cesarean delivery and perineal trauma.

RESULTS

The mean post-partum WBC count was 13.39 ± .24 × 10(9)/L (range 1.20-37.30 × 10(9)/L). There is a significant increase in the WBC after delivery (2.1 9 ± 3.33 × 10(9)/L) with significant differences according to mode of delivery (2.34 ± 3.48, 3.32 ± 3.69 and 1.6 0 ± 2.87 × 10(9)/L for spontaneous, assisted and cesarean deliveries. Multiple variables can affect post-partum leukocytosis, including: age, parity, gestational age, mode of delivery, type of anesthesia, timing of cesarean delivery in relation to labor onset and the extent of perineal trauma.

CONCLUSIONS

Post-partum leukocytosis is a physiological phenomenon with a wide normal variation and multiple contributing factors. As a single parameter, post-partum leukocytosis should not prompt further work up.

Changes in blood parameters in New Zealand White rabbits during pregnancy

Changes in clinical pathology parameters, particularly those related to blood coagulation, were examined throughout the gestation period in New Zealand White rabbits. As compared with the non-pregnant group, the following major changes were observed in the pregnant group. For blood coagulation-related parameters, platelets increased progressively and fibrinogen increased slightly from organogenesis, prothrombin time was significantly prolonged during organogenesis and shortened in the late fetal growth stage, activated partial thromboplastin time was significantly prolonged during the fetal growth stage, and antithrombin III increased during and after late organogenesis. Such changes in blood coagulation-related parameters during the later stages of gestation seem to be physiological responses in preparation for protecting against excessive haemorrhage or haemostasis at parturition. For the other haematological and blood chemical parameters as well as progesterone, red blood cell counts, haemoglobin and haematocrit began to decrease during organogenesis and continued to decrease thereafter. Reticulocyte counts significantly increased during organogenesis and decreased thereafter. White blood cell parameters, except for neutrophils, showed significant decreases during the fetal growth stage. Serum progesterone concentration reached its highest level early in organogenesis and decreased thereafter. Total protein, albumin, glucose, cholesterol, calcium, blood urea nitrogen and creatinine decreased significantly during the middle and/or late periods of gestation. In conclusion, the data obtained from the present study can be used as background data for effective evaluation of reproductive toxicology in rabbits, and pregnant rabbits may serve as models of pregnant women in research pertaining to clinical pathology and gestation.

Immature granulocyte detection by the SE-9000 haematology analyser during pregnancy

The objective of this study was to determine the nature of the alarm for immature granulocytes appearing in haemograms from pregnant women, as detected by the immature cell information channel (IMI) of the SE-9000 automated haematology analyser. Of all tests run on pregnant women in a 4-month period (n = 698), the first 100 haemograms with immature granulocyte alarms (14.33%) were collected. Each of these samples was then stained with Wright-Giemsa stain. The following variables were also analysed: age of the mother, trimester and days of gestation, type of delivery, weight and sex of the baby, and Apgar score. Most pregnant women were in the third trimester of gestation (82%) when an alarm was noted on the IMI channel. Of the patients, 62% had normal deliveries. The most frequent complication was obstructed delivery (23%). Mean percentages by microscopic counts of band cells, metamyelocytes, and myelocytes were 2.99, 0.45, and 0.19%, respectively. There was a statistically significant correlation for all cell types between the SE-9000 and the manual count method. No association was observed between the presence of immature granulocytes and the clinical variables analysed. The SE-9000 analyser shows high sensitivity in the IMI channel for detection of immature forms.

Pregnancy dating in the rat: placental morphology and maternal blood parameters

The rat is commonly used as a model in studies on embryology and reproduction toxicology. Surprisingly, the current literature does not provide a comprehensive reference data set on placental development in rat. Therefore, we have evaluated morphological changes of the placenta and maternal blood parameters during pregnancy of the Sprague-Dawley rat. The morphologic data presented in this study may be useful as reference material. This study revealed that placental development in the rat is a well-defined process, characterized by key synchronized morphological events at specific points in time, convenient for laboratory practice and provides the toxicologist with a sensitive tool to distinguish between normal and abnormal placental development and to detect fetal and placental mismatches. During rat pregnancy, significant changes were observed in maternal blood parameters strongly reminiscent of those observed in pregnant women. These changes included: (a) decreased blood cell volume as a result of hemodilution, (b) increased white blood cell counts reflecting the response of the mother to the fetal allograft, (c) increased blood clotting values, (d) decreased plasma glucose and increased lipid content maximizing fetal glucose availability and maternal energy conservation, and (e) decreased electrolyte values reflecting plasma volume expansion. It was concluded that the combined data set on placental morphology and maternal blood parameters in pregnant rats provides powerful tools for recognition of abnormal pregnancies.

Changes in clinical pathology parameters during gestation in the New Zealand white rabbit

Hematology and serum chemistry parameters were analyzed in 2 groups of pregnant rabbits to assess changes in these parameters over the course of gestation. These data were used to generate a historical control reference range for embryofetal development regulatory toxicology studies. During the 28-day gestation period, the following major changes were observed. Red blood cell counts, hemoglobin, and hematocrit increased slightly up to day 13 and subsequently decreased progressively to a nadir for all parameters on day 25. Reticulocyte counts increased maximally by day 16 and then decreased to a minimum value on day 28. White blood cell counts progressively declined after day 7. Platelet counts increased slightly by day 10, were relatively stable until day 13, then progressively decreased to a nadir on day 25. Aspartate aminotransferase and alanine aminotransferease values increased steadily throughout the study to reach a maximum value on day 25. Triglycerides increased to their maximum value by day 19 and then steadily decreased until day 28, whereas cholesterol decreased progressively to reach a nadir on day 25. Urea and total protein decreased steadily from day 13 onward. Calcium values decreased throughout the study to reach a minimum value on day 28. Phosphorus values increased slightly on days 7 and 13 and then progressively decreased to reach a nadir on day 28. With a few exceptions, changes that occur in clinical pathology parameters during pregnancy in the rabbit are similar to those observed in pregnant women. Therefore, the rabbit can be considered a suitable species for embryofetal development toxicity studies with regard to clinical pathology.

Hematological variables in cord blood of neonates of smoking and nonsmoking mothers

Smoking during pregnancy is associated with maternal and fetal complications. In the present study the effect of maternal smoking on neonatal cellular blood components was investigated. The values of whole blood cell count, leukocyte differential count, and thrombocyte and reticulocyte counts were determined and compared in cord blood of neonates of nonsmoking (n = 89) and smoking (n = 53) mothers. The variables of the erythrocyte and thrombocyte count were not different in cord blood of neonates who were exposed to smoke and in those who were not. In the reticulocyte range the reticulocyte count was significantly lower in the smoking group, while the reticulocyte subsets remained stable. The neutrophils were significantly lower in cord blood of neonates of smoking mothers (p < 0.05). The latter finding might be an explanation for the enhanced incidence of postnatal infection seen in children of smoking mothers.