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Sekiguchi M, Muromoto J, Ogawa K, Ozawa K, Miyasaka N, Sago H. Longitudinal hematological change in uncomplicated twin pregnancies: The white blood cell count decreases through pregnancy after the first trimester. Taiwan J Obstet Gynecol 2024; 63:381-386. [PMID: 38802202 DOI: 10.1016/j.tjog.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVE Longitudinal hematological changes throughout twin pregnancies have not been reported. This study aimed to reveal longitudinal changes in hematological indices in twin pregnancies. MATERIALS AND METHODS We conducted a retrospective chart review of hematological changes in uncomplicated twin pregnancies delivered at ≥37 weeks of gestation between 2010 and 2013 and randomly selected uncomplicated singletons during the same period. A complete blood count and hemogram were performed as blood examinations in the first trimester (9-13 weeks), late second trimester (22-27 weeks), mid-third trimester (33-35 weeks, only in twin pregnancies), and late third trimester (36-38 weeks). We evaluated inter-trimester differences in hematological indices and compared the values between twin and singleton pregnancies in each trimester. RESULTS The final analysis group included 60 twin pregnancies and 63 singleton pregnancies. The white blood cell (WBC) count in twin pregnancies decreased throughout the pregnancy after the first trimester and became significantly lower than that in singletons in the late third trimester. The WBC count showed only a slight decrease in the third trimester in singleton pregnancies, whereas it showed a marked decrease throughout the pregnancy in twin pregnancies. The marked decrease in the total WBC count in twin pregnancies is mainly due to a decrease in neutrophils. The red blood cell count and hemoglobin and hematocrit values in twin pregnancies showed more marked decreases in the second trimester than in singletons. No decrease was observed after the second trimester of pregnancy. The platelet count decreased in the third trimester of twin pregnancies. CONCLUSION We clarified the longitudinal hematological changes in twin pregnancies that showed augmentation of or differed from those of singleton pregnancies. It should be specifically mentioned that the WBC count markedly decreased through pregnancy after the first trimester, which is a characteristic change in twin pregnancies.
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Affiliation(s)
- Masaki Sekiguchi
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan; Department of Obstetrics and Gynecology, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Jin Muromoto
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Kohei Ogawa
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Katsusuke Ozawa
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Naoyuki Miyasaka
- Department of Obstetrics and Gynecology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Haruhiko Sago
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
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Moltubak E, Landerholm K, Blomberg M, Andersson RE. Validation of the Appendicitis Inflammatory Response (AIR) score during pregnancy: A nested case-control study. Acad Emerg Med 2024. [PMID: 38597185 DOI: 10.1111/acem.14915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVES Appendicitis poses diagnostic challenges. A correct diagnosis is important during pregnancy to avoid unnecessary surgery on the one hand and delayed surgery on the other hand, as both may negatively affect pregnancy outcomes. Clinical scores for risk-stratified management of suspected appendicitis are well established in adults but have not been validated during pregnancy. This nested case-control study evaluated the diagnostic accuracy of the Appendicitis Inflammatory Response (AIR) score and imaging during pregnancy. METHODS By cross-linking national Swedish health registries from a defined geographical area, we identified a cohort of 154 women who underwent appendectomy for suspected appendicitis during pregnancy and a matched cohort of 232 pregnant women admitted for acute abdominal pain and suspected appendicitis but with a discharge diagnosis of nonspecific abdominal pain (NSAP). All variables were extracted from medical records. The diagnostic value of AIR score and imaging was estimated for patients with a final diagnosis of appendicitis compared with patients with negative appendectomy and NSAP patients. RESULTS The final diagnoses for the operated patients were uncomplicated and complicated appendicitis in 49.4% and 26.6%, respectively, and negative appendectomy in 24.0%. Nearly half of all the patients underwent diagnostic imaging (41%), mainly by ultrasonography. The sensitivity and specificity of diagnostic imaging were 44.9% (95% CI 32.9%-57.4%) and 42.2% (95% CI 31.9%-53.1%), respectively. The area under the receiver operating characteristic curve of AIR score was 0.88 (95% CI 0.84-0.92) for all appendicitis and 0.90 (95% CI 0.84-0.95) for complicated appendicitis. The sensitivity for complicated appendicitis was 100% at a score of ≥4. The specificity for all appendicitis was 97% at a score of ≥9. CONCLUSIONS The results of this study suggest that the AIR score may be a suitable diagnostic tool for risk stratification of pregnant women with abdominal pain and suspected appendicitis but further validation among pregnant women is needed.
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Affiliation(s)
- Elin Moltubak
- Department of Surgery, County Hospital Ryhov, Jönköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Kalle Landerholm
- Department of Surgery, County Hospital Ryhov, Jönköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Marie Blomberg
- Department of Surgery, County Hospital Ryhov, Jönköping, Sweden
- Department of Obstetrics and Gynecology, Linköping University Hospital, Linköping, Sweden
| | - Roland E Andersson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Futurum Academy for Health and Care, Jönköping County Council, Jönköping, Sweden
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Zhu J, Li Z, Deng Y, Lan L, Yang J. Comprehensive reference intervals for white blood cell counts during pregnancy. BMC Pregnancy Childbirth 2024; 24:35. [PMID: 38182972 PMCID: PMC10768452 DOI: 10.1186/s12884-023-06227-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/26/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND White blood cell (WBC) count increases during pregnancy, necessitating reliable reference intervals for assessing infections and pregnancy-related complications. This study aimed to establish comprehensive reference intervals for WBC counts during pregnancy. METHODS The analysis included 17,737 pregnant women, with weekly WBC count measurements from pre-pregnancy to postpartum. A threshold linear regression model determined reference intervals, while Harris and Boyd's test partitioned the intervals. RESULTS WBC count exhibited a significant increase during pregnancy, characterized by a rapid rise before 7 weeks of gestation, followed by a plateau. Neutrophils primarily drove this increase, showing a similar pattern. The threshold regression model and Harris and Boyd's test supported partitioned reference intervals for WBC counts: 4.0-10.0 × 10^9/L for < = 2 weeks, 4.7-11.9 × 10^9/L for 3-5 weeks, and 5.7-14.4 × 10^9/L for > = 6 weeks of gestation. These reference intervals identified pregnant women with high WBC counts, who had a higher incidence of pregnancy-related complications including placenta previa, oligohydramnios, secondary uterine inertia, and intrauterine growth restriction. CONCLUSION This study establishes comprehensive reference intervals for WBC counts during pregnancy. Monitoring WBC counts is clinically relevant, as elevated levels are associated with an increased risk of infection and pregnancy-related complications.
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Affiliation(s)
- Jinxiu Zhu
- Longgang Maternity and Child Institute of Shantou University Medical College, Shenzhen, Guangdong, 518172, China
- Clinical Research Center, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, 515041, China
| | - Zexin Li
- Longgang Maternity and Child Institute of Shantou University Medical College, Shenzhen, Guangdong, 518172, China
- Clinical Research Center, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, 515041, China
| | - Yuguo Deng
- Department of Obstetrics, Longgang District Maternity and Child Healthcare Hospital of Shenzhen City, Shenzhen, Guangdong, 518172, China
- Longgang Maternity and Child Institute of Shantou University Medical College, Shenzhen, Guangdong, 518172, China
| | - Liting Lan
- Longgang Maternity and Child Institute of Shantou University Medical College, Shenzhen, Guangdong, 518172, China
- Clinical Research Center, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, 515041, China
| | - Jinying Yang
- Department of Obstetrics, Longgang District Maternity and Child Healthcare Hospital of Shenzhen City, Shenzhen, Guangdong, 518172, China.
- Longgang Maternity and Child Institute of Shantou University Medical College, Shenzhen, Guangdong, 518172, China.
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Wang X, Zhang YY, Xu Y. Pregnancy-induced leukocytosis: A case report. World J Clin Cases 2022; 10:13349-13355. [PMID: 36683643 PMCID: PMC9851002 DOI: 10.12998/wjcc.v10.i36.13349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/24/2022] [Accepted: 11/30/2022] [Indexed: 12/26/2022] Open
Abstract
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.
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Affiliation(s)
- Xi Wang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China
| | - Yang-Yang Zhang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China
| | - Yang Xu
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China
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Bohn MK, Adeli K. Physiological and metabolic adaptations in pregnancy: importance of trimester-specific reference intervals to investigate maternal health and complications. Crit Rev Clin Lab Sci 2021; 59:76-92. [PMID: 34587857 DOI: 10.1080/10408363.2021.1978923] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Diagnosis, prognostication, and monitoring of maternal health throughout pregnancy relies on laboratory testing, including but not limited to key markers of thyroid, hepatic, cardiac, hematology, and renal function. Dynamic physiological processes during gestation significantly influence the maternal biochemistry that supports both the mother and fetus. Resultant changes in blood biochemistry alter the expected values of common laboratory tests. However, the importance of pregnancy-specific reference intervals for laboratory test result interpretation and appropriate monitoring of maternal health and complications is underappreciated. Most clinical laboratories continue to use non-pregnant adult reference intervals for laboratory test interpretation in pregnancy. The current review summarizes and critically evaluates the available literature regarding physiological and metabolic adaptations in pregnancy and their influence on common biomarkers of health and disease. The main laboratory parameters discussed include thyroid, hepatic, metabolic, renal, hematology, inflammatory, and cardiac markers. Considering the available data, further studies are urgently needed to establish trimester-specific reference intervals in healthy pregnant women on updated analytical platforms. Without such data, the standard of clinical laboratory service in pregnancy remains compromised and affects the quality of maternal-fetal healthcare.
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Affiliation(s)
- Mary Kathryn Bohn
- CALIPER Program, Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Khosrow Adeli
- CALIPER Program, Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
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Banyeh M, Amidu N, Quaye L. The relationship between 2D:4D ratio and postpartum adult female variables in a Ghanaian population. Am J Hum Biol 2021; 34:e23680. [PMID: 34523769 DOI: 10.1002/ajhb.23680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES Postpartum hematological and anthropometric assessment is a requirement for optimal maternal and child health. The study aimed to determine the relationship between the 2D:4D ratio and postpartum hematological and anthropometric variables in adult females. METHODS The study was cross-sectional from December 2020 to April 2021 involving 272 postpartum adult females, aged between 18 and 36 years. The right (2D:4DR) and the left (2D:4DL) digit ratios were measured using computer-assisted analysis. Fasting venous samples were collected at a median (interquartile range) of 111 (44-210) days postpartum and analyzed for total testosterone (TT), estradiol, sex hormone-binding globulin, and complete blood count. RESULTS The mean ± standard deviation 2D:4DR and 2D:4DL were 0.94 ± 0.04 and 0.93 ± 0.04, respectively. As expected, the TT (r = -0.198, p = .015) and the free androgen index (FAI: r = -0.186, p = .019) were inversely correlated with the 2D:4DL while free testosterone (FT%: r = -0.157, p = .038) was inversely correlated with the 2D:4DR. The absolute basophile count (BASO: r = -0.124, p = .040) and the Platelet-lymphocyte ratio (PLR: r = -0.153, p = .016) were inversely correlated with the 2D:4DL and the 2D:4DR respectively. In addition, the mean cell volume was inversely correlated with the 2D:4DR (r = -0.139, p = .024) and the 2D:4DL (r = -0.122, p = .045). Moreover, the 2D:4DR was inversely correlated with height (r = -0.164, p = .007). Unexpectedly, the red blood cell count (RBC: r = 0.138, p = .025) was positively correlated with the 2D:4DR. CONCLUSION There are significant relationships between the 2D:4D ratio and postpartum female variables. These findings are useful preliminary reference data for postpartum research and subsequent 2D:4D ratio studies.
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Affiliation(s)
- Moses Banyeh
- Department of Biomedical Laboratory Science, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Nafiu Amidu
- Department of Biomedical Laboratory Science, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Lawrence Quaye
- Department of Biomedical Laboratory Science, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
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Neutrophil to Lymphocyte Ratio in Maternal Blood: A Clue to Suspect Amnionitis. J Clin Med 2021; 10:jcm10122673. [PMID: 34204466 PMCID: PMC8235298 DOI: 10.3390/jcm10122673] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/13/2021] [Accepted: 06/15/2021] [Indexed: 11/17/2022] Open
Abstract
There is no information about whether maternal neutrophil to lymphocyte ratios (NLRs) progressively increase with respect to the progression of acute histologic chorioamnionitis (acute-HCA) and increased maternal NLR is a risk factor for amnionitis, known as advanced acute-HCA, in pregnant women at risk for spontaneous preterm birth (PTB). The objective of the current study is to examine this issue. The study population included 132 singleton PTB (<34 weeks) due to either preterm labor or preterm-PROM with both placental pathology and maternal CBC results within 48 h before delivery. We examined maternal NLRs according to the progression of acute-HCA in extra-placental membranes (EPM) (i.e., group-0, inflammation-free EPM; group-1, inflammation restricted to decidua; group-2, inflammation restricted to the membranous trophoblast of chorion and the decidua; group-3, inflammation in the connective tissue of chorion but not amnion; group-4, amnionitis). Maternal NLRs significantly and progressively increased with the progression of acute-HCA (Spearman’s rank correlation test, γ = 0.363, p = 0.000019). Moreover, the increased maternal NLR (≥7.75) (Odds-ratio 5.56, 95% confidence-interval 1.26-24.62, p < 0.05) was a significant independent risk factor for amnionitis even after the correction for potential confounders. In conclusion, maternal NLRs significantly and progressively increased according to the progression of acute-HCA and the increased maternal NLR (≥7.75) was an independent risk factor for amnionitis in spontaneous PTB. The evaluation of the performance of NLR should clearly require a prospective description of this parameter in a cohort of patients with either threatened PTL or preterm-PROM.
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Klymets HV, Iskra RY, Svarchevska OZ. Hematological parameters and protein metabolism in the blood of pregnant rats under the effect of vanadium citrate. REGULATORY MECHANISMS IN BIOSYSTEMS 2021. [DOI: 10.15421/022122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Dose-dependent changes in protein metabolism in the blood and hematological parameters of pregnant rats under the effect of vanadium citrate are presented in the article. The animals were divided into five groups: group I – non-pregnant females, II – pregnant females consuming pure water without additives, III, IV, V – females which during the mating and pregnancy period received the solution of vanadium citrate at concentrations of 0.03, 0.125 and 0.50 μg V/mL water. The research findings show that in pregnant animals of group II, the level of urea and alkaline phosphatase activity increased, meanwhile aspartate aminotransferase activity decreased, as compared to the non-pregnant females of group І. The levels of total protein and albumin decreased; however, the content of β-globulins increased in the pregnant animals of group II, as compared with that in group I. Also, in the rats of group II, there was a decrease in hemolysis time, total content of erythrocytes and hemoglobin, the content of old and mature erythrocytes, while the content of young erythrocytes increased, as compared to group I. The platelet content and thrombocrit in rats of group II increased in comparison with group I. The content of leukocytes and lymphocytes in pregnant animals of group II decreased, while the content of granulocytes increased, in contrast to non-pregnant rats. Under the effect of vanadium citrate at concentrations of 0.03–0.50 μg V/mL, there was a significant increase in the maximum number of prohemolized erythrocytes, the time of maximum hemolysis was delayed by 0.4–0.6 min, as compared with the pregnant rats of group II. This did not affect the time of total hemolysis in rats of groups III and V, as compared with the pregnant animals in group II. Under the effect of vanadium citrate, an increase in the content of young erythrocytes was observed, as compared with group II. The hemoglobin content decreased at the concentration of 0.125 μg V/mL, while at the concentration of 0.50 μg V/mL it increased, as compared to the pregnant animals of group II. Also, under the effect of vanadium citrate there was a decrease in the mean hemoglobin concentration in the erythrocyte. In pregnant animals fed with vanadium citrate solutions, the platelet content and thrombocrit, the relative width of platelet distribution by volume decreased, as compared with the pregnant rats of group II. The content of leukocytes, lymphocytes and granulocytes under the effect of vanadium citrate increased, as compared with the pregnant animals in group II. Under the effect of vanadium citrate at the concentration of 0.03 μg V/mL, the level of albumin, creatinine and aspartate aminotransferase activity increased in blood plasma in comparison with group II. Meanwhile, at the concentration of 0.125 μg V/mL, the relative content of γ-globulins and aspartate aminotransferase activity increased, alkaline phosphatase activity and urea level decreased in comparison with group II. However at the concentration of 0.50 μg V/mL, the relative α- and γ-globulins content and aspartate aminotransferase activity increased, at the same time, the relative β-globulins content and urea level decreased in comparison with group II. Therefore, vanadium citrate normalizes the indicators of protein metabolism during pregnancy, thus it can be considered as a potential dietary drug for the pregnant.
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Mengistu Sissay T, Tibebu M, Wasihun T, Tsegaye A. Hematological reference intervals for adult population of Dire Dawa town, East Ethiopia. PLoS One 2021; 16:e0244314. [PMID: 33591978 PMCID: PMC7886208 DOI: 10.1371/journal.pone.0244314] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 12/07/2020] [Indexed: 11/18/2022] Open
Abstract
Background Reference interval (RI) for hematological parameters is used to interpret laboratory test results in the diagnosis, management and monitoring of hematologic disorders. Several factors including sex, age, dietary patterns, pregnancy status, ethnicity and geographic location affect hematological RIs. However, manufacturers derived reference value is currently in use in most developing countries including Ethiopia. This study aimed to establish hematological RIs for adult population living in Dire Dawa town, East Ethiopia. Methods In this cross-sectional study, 513 apparently healthy adults of Dire Dawa town were enrolled from January to March 2019. From these, 342 (171 males and 171 non-pregnant females) were aged 18–65 years while 171 were pregnant women aged 15–49 years. After obtaining written informed consent, 5ml fresh whole blood was collected of which 2ml was used for hematologic analysis using Mindray BC-3000plus hematology analyzer and 3ml for serological tests. The 2.5th and 97.5th RI was computed by non-parametric test employing SPSS version 24. P-value <0.05 was considered statistically significant. Result Males had significantly higher reference value for most of red cell parameters (Hgb, RBC, HCT, MCH and MCHC) than females (p <0.05), while most of the WBC parameters were significantly higher in females than males. Moreover, non-pregnant women had higher values for most of red cell parameters than pregnant women. Pregnant women had higher WBC parameters than their non-pregnant counterparts. Conclusion The hematologic RIs obtained in this study shows variation between genders, between pregnant and non-pregnant women, from the clinical practice currently utilised in Dire Dawa town and from studies conducted in Ethiopia, African countries as well as the Western population. It underscores the need for utilising gender and pregnancy specific, locally derived hematologic RI for better management, diagnosis and monitoring of hematologic disorders for adults of both genders and pregnant women.
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Affiliation(s)
| | - Melatwork Tibebu
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Aster Tsegaye
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Lukenaite B, Luksaite-Lukste R, Mikalauskas S, Samuilis A, Strupas K, Poškus T. Magnetic resonance imaging reduces the rate of unnecessary operations in pregnant patients with suspected acute appendicitis: a retrospective study. Ann Surg Treat Res 2020; 100:40-46. [PMID: 33457396 PMCID: PMC7791189 DOI: 10.4174/astr.2021.100.1.40] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/26/2020] [Accepted: 10/09/2020] [Indexed: 12/26/2022] Open
Abstract
Purpose This is a retrospective single-institution study performed to compare the rate of unnecessary operations in pregnant women with suspected acute appendicitis with and without the use of MRI. Methods The study subjects were all pregnant women with suspected acute appendicitis admitted to a tertiary institution from January 2012 to December 2019. If acute appendicitis was not excluded clinically and by ultrasound (US), laparoscopies were performed until May 2017 (US-only group). MRI was added as a diagnostic tool when US was inconclusive from May 2017 (US + MRI group). Surgery was considered unnecessary when no inflamed appendix was found. The rate of unnecessary surgery, postoperative complications, length of stay were analyzed. Results Seventy-six women were included in the study; 38 women in the US-only group and 38 women in the US + MRI group. There were no differences in admission characteristics between the groups. One of 38 women (2.6%) underwent unnecessary surgery in the US + MRI group vs. 10 of 38 (26.3%) in the US-only group (P = 0.007). The patients in the US + MRI group were significantly less likely to undergo a diagnostic operation than in the US-only group (5.26% vs. 55.3%, respectively; P < 0.001) and their hospital stay was significantly shorter (0.74 ± 1.64 days vs. 3.7 ± 3.0 days, respectively; P < 0.001). The obstetric outcomes were not different between the groups. MRI had a sensitivity of 83.3% and specificity of 100% in the series. Conclusion The rate of unnecessary surgery was significantly reduced in pregnant women, who underwent MRI after inconclusive transabdominal US.
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Affiliation(s)
- Beatrice Lukenaite
- Clinic of Gastroenterology, Nephro-Urology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Raminta Luksaite-Lukste
- Department of Radiology, Nuclear Medicine and Medical Physics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Saulius Mikalauskas
- Clinic of Gastroenterology, Nephro-Urology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Arturas Samuilis
- Department of Radiology, Nuclear Medicine and Medical Physics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Kestutis Strupas
- Clinic of Gastroenterology, Nephro-Urology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Tomas Poškus
- Clinic of Gastroenterology, Nephro-Urology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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Srebnik N, Michaeli J, Shalev L, Ruchlemer R, Farkash R, Grisaru-Granovsky S. The maternal leukocyte count at admission for labor is indicative of early maternal postpartum infectious morbidity and adverse neonatal outcome. Eur J Obstet Gynecol Reprod Biol 2020; 258:9-15. [PMID: 33387983 DOI: 10.1016/j.ejogrb.2020.12.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/14/2020] [Accepted: 12/18/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Investigate the association between maternal leukocyte count at admission for labor and postpartum infectious maternal morbidity (PPIM) following vaginal delivery. STUDY DESIGN Retrospective cohort study, 2005-2017. Afebrile women, term, singleton, vaginal delivery included. Maternal leukocyte/differential at admission for labor and 24 h postpartum were analyzed as continuous values and quintiles. Pre/postpartum difference (Δleukocyte) was calculated. The primary outcome was maternal PPIM, early and late. The secondary outcome was adverse neonatal outcomes (ANO). RESULTS 58,174 eligible deliveries out of168,979 (34.4 %); 1068 (1.8 %) women with PPIM. The rate rose linearly from 1.4 % for the lowest admission for labor leukocyte quantile to 2.7 % for the highest quantile, p for trend <0.001. The women with early PPIM had significantly higher admission levels of leukocytes (mean): 12.04 ± 3.43 vs. 11.18 ± 2.86 × 10^3/μl; neutrophils, 9.48 ± 3.46 vs. 8.40 ± 2.67 × 10^3/μl; and monocytes 0.76 ± 0.25 vs. 0.72 ± 0.23 × 10^3/μl); p < 0.001 for all. The mean leukocyte count for women with PPIM diagnosis, including only postpartum fever, was 12.06 ± 2.64; significantly higher than in the non-PPIM group, p = 0.014. A Δleukocyte value of >3.7 × 10^3/μl is significantly associated with PPIM, aOR 2.10 [1.82-2.41]. No significant association between leukocyte count or Δleukocyte and maternal readmission rate due to infectious complications. 386 neonates (0.7 %) had records of ANO and 64 neonates (0.1 %) had records of neonatal sepsis, positive linear association; p for trend < 0.001. The maternal Δleukocyte value of >3.7 × 10^3/μl was found to be significantly associated with the risk for ANO, aOR 1.5[1.19-1.90]. CONCLUSION In healthy women, an elevated level of the leukocyte count at admission for labor and the Δleukocyte are significant risk predictors of PPIM and ANO.
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Affiliation(s)
- Naama Srebnik
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated With the Hebrew University School of Medicine, Jerusalem, Israel
| | - Jennia Michaeli
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated With the Hebrew University School of Medicine, Jerusalem, Israel.
| | - Ligal Shalev
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated With the Hebrew University School of Medicine, Jerusalem, Israel
| | - Rosa Ruchlemer
- Department of Hematology, Shaare Zedek Medical Center, Affiliated With the Hebrew University School of Medicine, Jerusalem, Israel
| | - Rivka Farkash
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated With the Hebrew University School of Medicine, Jerusalem, Israel
| | - Sorina Grisaru-Granovsky
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated With the Hebrew University School of Medicine, Jerusalem, Israel
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12
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Gruzieva O, Merid SK, Chen S, Mukherjee N, Hedman AM, Almqvist C, Andolf E, Jiang Y, Kere J, Scheynius A, Söderhäll C, Ullemar V, Karmaus W, Melén E, Arshad SH, Pershagen G. DNA Methylation Trajectories During Pregnancy. Epigenet Insights 2019; 12:2516865719867090. [PMID: 31453433 PMCID: PMC6696836 DOI: 10.1177/2516865719867090] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 07/10/2019] [Indexed: 01/03/2023] Open
Abstract
There is emerging evidence on DNA methylation (DNAm) variability over time; however, little is known about dynamics of DNAm patterns during pregnancy. We performed an epigenome-wide longitudinal DNAm study of a well-characterized sample of young women from the Swedish Born into Life study, with repeated blood sampling before, during and after pregnancy (n = 21), using the Illumina Infinium MethylationEPIC array. We conducted a replication in the Isle of Wight third-generation birth cohort (n = 27), using the Infinium HumanMethylation450k BeadChip. We identified 196 CpG sites displaying intra-individual longitudinal change in DNAm with a false discovery rate (FDR) P < .05. Most of these (91%) showed a decrease in average methylation levels over the studied period. We observed several genes represented by ⩾3 differentially methylated CpGs: HOXB3, AVP, LOC100996291, and MicroRNA 10a. Of 36 CpGs available in the replication cohort, 17 were replicated, all but 2 with the same direction of association (replication P < .05). Biological pathway analysis demonstrated that FDR-significant CpGs belong to genes overrepresented in metabolism-related pathways, such as adipose tissue development, regulation of insulin receptor signaling, and mammary gland fat development. These results contribute to a better understanding of the biological mechanisms underlying important physiological alterations and adaptations for pregnancy and lactation.
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Affiliation(s)
- Olena Gruzieva
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden,Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden,Olena Gruzieva, Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, SE-171 77 Stockholm, Sweden.
| | - Simon Kebede Merid
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Su Chen
- Division of Epidemiology, Biostatistics, and Environmental Health Science, School of Public Health, The University of Memphis, Memphis, TN, USA
| | - Nandini Mukherjee
- Division of Epidemiology, Biostatistics, and Environmental Health Science, School of Public Health, The University of Memphis, Memphis, TN, USA
| | - Anna M Hedman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Ellika Andolf
- Department of Clinical Sciences, Division of Obstetrics and Gynaecology, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Yu Jiang
- Division of Epidemiology, Biostatistics, and Environmental Health Science, School of Public Health, The University of Memphis, Memphis, TN, USA
| | - Juha Kere
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden,Molecular Neurology Research Program, University of Helsinki and Folkhälsan Institute of Genetics, Helsinki, Finland,School of Basic & Medical Biosciences, King’s College London, London, UK
| | - Annika Scheynius
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden,Sachs’ Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden,Clinical Genomics, Science for Life Laboratory, Stockholm, Sweden
| | - Cilla Söderhäll
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden,Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Vilhelmina Ullemar
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Wilfried Karmaus
- Division of Epidemiology, Biostatistics, and Environmental Health Science, School of Public Health, The University of Memphis, Memphis, TN, USA
| | - Erik Melén
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden,Sachs’ Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Syed Hasan Arshad
- The David Hide Asthma and Allergy Research Centre, Newport, UK,Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden,Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
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