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Singhal K, Gupta S, Tiwari S, Pinjar MJ. A Case-Control Study Utilizing Red Cell Distribution Width as a Bio-Inflammatory Marker in Pre-eclampsia. Cureus 2024; 16:e55910. [PMID: 38601404 PMCID: PMC11003858 DOI: 10.7759/cureus.55910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2024] [Indexed: 04/12/2024] Open
Abstract
INTRODUCTION This research was conducted to assess the effectiveness of red cell distribution width (RDW) as an indicator for pre-eclampsia (PE), a condition characterized by elevated blood pressure and the presence of protein in the urine occurring beyond the 20th week of pregnancy. METHODOLOGY The case-control investigation spanned 10 months, following the acquisition of informed consent and the receipt of ethical clearance. The study sample comprised a total of 70 pregnant women, evenly divided into two groups: 35 cases of PE and 35 normotensive pregnant controls. Both the cases and controls provided 3 ml venous blood samples. The study employed a semi-automated three-part hematological analyzer to establish the baseline RDW for all individuals. RESULTS This study showed that the individuals with pre-eclampsia had a greater RDW compared to the healthy pregnant women. The observed difference was found to be statistically significant, with a p-value of 0.004. The receiver operating curve (ROC) analysis showed that RDW exhibited significant diagnostic accuracy in differentiating between cases and controls (area under the curve [AUC] = 0.71, P = 0.004) when employing a cut-off value of >= 18.25. The sensitivity was 80% and the specificity was 71.4%. CONCLUSION In contrast to other indicators of inflammation, RDW is a cost-effective and easily accessible biomarker that can be acquired from routine complete blood counts. It has the potential to be valuable in predicting and diagnosing pre-eclampsia.
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Affiliation(s)
| | - Shweta Gupta
- Department of Physiology, Prasad Institute of Medical Sciences, Lucknow, IND
| | - Sunita Tiwari
- Department of Physiology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND
| | - Mohammed Jaffer Pinjar
- Department of Physiology, All India Institute of Medical Sciences, Deoghar, Deoghar, IND
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Hassan AA, Musa SM, Omer HEO, Adam I. The association between red cell distribution width and newly diagnosed hypertension among adults in Northern Sudan: a case-control study. Libyan J Med 2023; 18:2254502. [PMID: 37665970 PMCID: PMC10478621 DOI: 10.1080/19932820.2023.2254502] [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] [Received: 05/12/2023] [Accepted: 08/29/2023] [Indexed: 09/06/2023] Open
Abstract
The existing data have shown inconsistency about the association between red cell distribution width (RDW) and hypertension. Thus, the aim of the present study was to investigate the association between RDW and newly diagnosed hypertension among adults in Sudan. This was a case-control study conducted in Northern Sudan from July to September 2022. The cases were patients with newly diagnosed hypertension (n = 78), and the controls were healthy participants (n = 78). A questionnaire was used to collect the participants' sociodemographic, and clinical data. RDW was measured using an automated hematology analyzer. A logistic regression analysis was performed. The univariate analysis revealed no association between sex, educational level, occupational level, RDW, and newly diagnosed hypertension. In the multivariate analysis, increasing age (adjusted odds ratio [AOR], 1.05; 95% confidence interval [CI], 1.02‒1.08) and body mass index (AOR, 1.12; 95% CI, 1.05‒1.19) were associated with newly diagnosed hypertension. No association was found between RDW and newly diagnosed hypertension. No correlation was found between RDW and systolic (r = 0.045, P = 0.577) or diastolic blood pressure (r = 0.023, P = 0.772). In conclusion, no association in RDW was found between the patients with newly diagnosed hypertension and the healthy controls.
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Affiliation(s)
- Ahmed A. Hassan
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Shaza M. Musa
- Adjunct instructor- Biology, Tarrant County College Northwest Campus, Fort Worth, TX, USA
| | - Husam-Eldin O. Omer
- Department of Pathology, Faculty of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Ishag Adam
- Department of Obstetrics and Gynecology, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Kingdom of Saudi Arabia
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Nori W, Harmoosh SK, Abd Al-Badri HJ. Can Red cell distribution width screen for metabolic abnormality in women with Polycystic Ovarian Syndrome? THE JOURNAL OF MEDICAL INVESTIGATION 2022; 69:191-195. [PMID: 36244769 DOI: 10.2152/jmi.69.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Polycystic ovarian syndrome (PCOS) is a prevalent endocrinopathy in reproductive-age females, accredited to a chronic low-grade inflammatory reaction. Red distribution width (RDW), a parameter of complete blood count, was tested as an inflammatory marker ; higher RDW was linked to metabolic syndrome. We aimed to examine RDW in distinguishing PCOS-related metabolic and hormonal abnormalities. Methods : A case-control study recruited 128 women, divided into PCOS cases (64 / 128) and controls (64 / 128) according to Rotterdam criteria. Body mass index (BMI), estimated complete blood count parameters, hormonal markers (serum follicle-stimulating hormone (FSH), luteinizing hormone, and serum testosterone), and metabolic markers (HOMA-IR, serum high and low-density lipoprotein) were measured. Results showed that RDW was significantly higher in PCOS. HOMA-IR, LDL, testosterone, and LH / FSH were higher in PCOS and strongly correlated with RDW with positive correlations. HDL was elevated and correlated negatively with RDW in PCOS. ROC calculated (13.55) as RDW cut-off value for insulin-resistant with an AUC of 0.95, P < 0.001. In conclusion, a strong and remarkable correlation of RDW with metabolic abnormalities in PCOS cases with 100% sensitivity and specificity, in addition to being quick and inexpensive, makes it a reliable marker for screening for insulin resistance. J. Med. Invest. 69 : 191-195, August, 2022.
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Affiliation(s)
- Wassan Nori
- Assistant professor. College of Medicine / Department of Obstetrics and Gynecology Mustansiriyah University, Baghdad, Iraq. . ORCID Number : 0000-0002-8749-2444
| | - Shaima K Harmoosh
- IVF specialist PhD. Al Yarmouk Teaching Hospital / infertility clinic / Baghdad, Iraq . ORCID Number : 0000-0001-5527-9422
| | - Hadeel J Abd Al-Badri
- lecturer. College of Medicine / Department of Obstetrics and Gynecology Mustansiriyah University, Baghdad, Iraq. . ORCID Number 0000-0001-5604-7367
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Aslan MM, Yeler MT, Yuvacı HU, Cerci IA, Cevrioğlu AS, Ozden S. Can the neutrophil-to-lymphocyte ratio (NLR) predicts fetal loss in preeclampsia with severe features? Pregnancy Hypertens 2020; 22:14-16. [PMID: 32693328 DOI: 10.1016/j.preghy.2020.07.005] [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: 11/19/2019] [Revised: 07/08/2020] [Accepted: 07/11/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Preeclampsia (PE) is one of the most common causes of major maternal and fetal adverse events including mortality and preterm birth Grill et al. (2009). The neutrophil-to-lymphocyte ratio (NLR) and other hematologic indexes of systemic inflammation have been investigated in patients with PE for the prediction of the severity or presence of the disease. Despite these studies, we found no trials investigating the relationship between NLR and fetal outcomes in PE patients. In this study, we aimed to investigate the relationship between NLR and fetal outcomes. METHODS We retrospectively analyzed the demographic data and laboratory tests to determine the NLR of 175 pregnant women with severe PE admitted to our clinic between January 2015 and December 2018. RESULTS NLR in the first (2.4 ± 1.1 vs 2.9 ± 1.4, P = 0.18) and second trimesters (3.6 ± 0.7 vs 3.8 ± 1.3, P = 0.25) were not different between the groups, but third trimester NLR was significantly higher in patients with fetal loss (6.5 ± 5.4 vs 4.2 ± 2.7, P = 0.009). The area under the receiver operating characteristic curve for NLR in the third trimester was 0.66 and NLR > 3.9 predicted fetal loss with a sensitivity of 75% and a specificity of 61% (0.684, 95% confidence interval 0.48-0.83, P = 0.05). CONCLUSION We demonstrated that third trimester NLR is associated with fetal loss in patients with severe PE.
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Affiliation(s)
- Mehmet Musa Aslan
- Sakarya University Education and Research Hospital, Department of Obstetrics and Gynecology, Turkey.
| | | | - Hilal Uslu Yuvacı
- Sakarya University Education and Research Hospital, Department of Obstetrics and Gynecology, Turkey
| | - Ilker Ali Cerci
- Sakarya University Education and Research Hospital, Department of Obstetrics and Gynecology, Turkey
| | - Arif Serhan Cevrioğlu
- Sakarya University Education and Research Hospital, Department of Obstetrics and Gynecology, Turkey
| | - Selcuk Ozden
- Sakarya University Education and Research Hospital, Department of Obstetrics and Gynecology, Turkey
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Çintesun E, Incesu Çintesun FN, Ezveci H, Akyürek F, Çelik Ç. Systemic inflammatory response markers in preeclampsia. J Lab Physicians 2020; 10:316-319. [PMID: 30078969 PMCID: PMC6052816 DOI: 10.4103/jlp.jlp_144_17] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), platelet distribution width (PDW), red cell distribution width (RDW), mean platelet volume (MPV), and plateletcrit (PCT) are known as systemic inflammatory response markers. In this study, we aimed to evaluate changes in NLR, PLR, PDW, RDW, MPV, and PCT in preeclampsia (PE) and their use in predicting its severity. MATERIALS AND METHODS This is a retrospective case-control study. The study comprised 64 control group (healthy pregnant females), 51 females with mild PE, and 13 with severe PE. These three groups were compared with demographic data and inflammation markers. RESULTS There were no statistically significant differences between healthy pregnant females and preeclaptic females in terms of median age, hemoglobin, lymphocyte, neutrophil, platelet, NLR, PLR, PDV, RDW, MPV, PCT (P > 0.05). The control group has a higher number of gravity and parity than the PE group (P < 0.001). MPV value is a lower PE group than the control group (P < 0.001). Both gravity and parity were significantly higher in the patients with mild PE than in the control group (P < 0.001). MPV value was statistically higher in the control group compared both mild and severe PE (P < 0.001), however, no statistical difference between mild and severe PE (P = 0.305). CONCLUSIONS MPV may be clinically useful markers in the prediction of PE. Further, prospective multicenter studies are needed to reveal the association between these markers and PE.
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Affiliation(s)
- Ersin Çintesun
- Department of Obstetrics and Gynecology, Selcuk University, Konya, Turkey
| | | | - Huriye Ezveci
- Department of Obstetrics and Gynecology, Selcuk University, Konya, Turkey
| | - Fikret Akyürek
- Department of Biochemistry, Selçuk University, Konya, Turkey
| | - Çetin Çelik
- Department of Obstetrics and Gynecology, Selcuk University, Konya, Turkey
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Adam I, Mutabingwa TK, Malik EM. Red cell distribution width and preeclampsia: a systematic review and meta-analysis. Clin Hypertens 2019; 25:15. [PMID: 31338207 PMCID: PMC6628484 DOI: 10.1186/s40885-019-0119-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/10/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Preeclampsia is a serious pregnancy-related disease which may lead to adverse health effects to the mother and fetus. Besides many publications on the association of red cell distribution width (RDW) and preeclampsia, there has been no published meta-analysis. This necessitated the present systemic review and met-analysis to assess the RDW in relation to preeclampsia. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed. Relevant published studies were searched in PubMed, Cochrane library, Google scholar, Scopus, Embase and CINAHL using the term "Preeclampsia OR eclampsia AND red cell distribution width OR red blood cells). Modified Newcastle - Ottawa quality assessment scale was used for critical appraisal of retrieved studies. Pooled Meta logistic regression was computed using OpenMeta Analyst software. Subgroup and meta-regression methods were performed to analyse the heterogeneity. RESULTS Eleven case control studies were included in the met-analyses with a total of 951 cases (preeclampsia) and 2024 controls. The mean (SD) of the RDW level was significantly higher in women with preeclampsia compared to controls [15.10 (2.48) % vs. 14.26(1.71) %, P < 0.001]. The mean difference was 0.85, 95% CI = 0.26-1.43. Due to a high heterogeneity (I2 = 90.45, P < 0.001), the continuous random effect model was used.Eight studies compared RDW level in the mild (N = 360) with severe cases (N = 354) of preeclampsia. The RDW level was significantly higher in women with severe preeclampsia compared to those with mild preeclampsia [15.37 (2.48) % vs. 14.037(1.79) %, P < 0.001]. The mean difference was 1.07, 95% CI = 0.45-1.70. Since there is a high heterogeneity [I2 = 76.67, P < 0.001], the continuous random effect model was used.Through the met-regression model, except for the region of the study (P < 0.001), none of investigated variables (age, parity, quality of the study) was significantly associated with the investigated heterogeneity. The outliers (3studies) were removed to reduce the heterogeneity. The pooled meta-analysis of the remaining 8 studies showed a significant difference in the RDW between preeclamptic women compared with the controls. The mean difference was 0.93, 95% CI = 0.56-1.31, P < 0.001. Because of heterogeneity [I2 = 69.6, P = 0.002], the continuous random effect model was used. CONCLUSION RDW level was significantly higher in women with preeclampsia compared to controls. Similarly, women with severe preeclampsia had significantly higher RDW than those with the mild form.
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Affiliation(s)
- Ishag Adam
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
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Mtali YS, Lyimo MA, Luzzatto L, Massawe SN. Hypertensive disorders of pregnancy are associated with an inflammatory state: evidence from hematological findings and cytokine levels. BMC Pregnancy Childbirth 2019; 19:237. [PMID: 31288789 PMCID: PMC6617701 DOI: 10.1186/s12884-019-2383-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/27/2019] [Indexed: 01/20/2023] Open
Abstract
Background Abnormalities of blood cell counts and of cytokine profiles in women with hypertensive disorders of pregnancy (HDP) have been reported in several studies. Although their cause-effect relationships to HDP are not yet clear, detecting and monitoring these alterations can be of use for prognosis and management of HDP. This study aimed to determine hematological, coagulation and cytokine profiles in hypertensive as compared to normotensive pregnancy and to identify correlations between these profiles. Methods This was a hospital-based comparative cross-sectional study conducted from September 2017 to February 2018. There were two groups: the comparison group consisted of 77 normotensive pregnant women attending the antenatal clinic of Muhimbili National Hospital (MNH); the index group consisted of 76 hypertensive pregnant women admitted to the maternity block of the same hospital. Hematological and cytokine parameters were compared between the hypertensive and the normotensive group. We analyzed the data using Student’s independent t-test when the data were normally distributed; and the Mann–Whitney U-test when the data were not normally distributed. Kruskal Wallis with Dunn’s multiple comparison tests was run for subgroup analysis and correlation studies were done using Spearman ranking. Results Hemoglobin levels were slightly but significantly lower, (P < 0.01) in women with HDP compared to normotensive (N) women; the same was true for platelet counts (P < 0.001). The red cell distribution width (RDW) was slightly but significantly higher in HDP than in N. Neutrophil counts and Interleukin 6 (IL-6) levels were significantly (P < 0.001) higher in HDP than in N; and within HDP IL-6 levels increased with increasing severity of HDP. A novel remarkable finding was that eosinophil counts, normal in N, were lower and lower with increasing severity of HDP, to the point that they were nearly absent in women with eclampsia. Conclusion There are significant changes in hematological, cytokine and coagulation parameters in pregnant women with hypertensive disorders compared to normotensive pregnant women. The picture that emerges is that of an inflammatory state associated with hypertensive disorders of pregnancy.
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Affiliation(s)
- Yohana Silas Mtali
- Department of Hematology and blood transfusion, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania.
| | - Magdalena Amani Lyimo
- Department of Hematology and blood transfusion, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Lucio Luzzatto
- Department of Hematology and blood transfusion, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Siriel Nanzia Massawe
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
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Paliogiannis P, Zinellu A, Mangoni AA, Capobianco G, Dessole S, Cherchi PL, Carru C. Red blood cell distribution width in pregnancy: a systematic review. Biochem Med (Zagreb) 2019; 28:030502. [PMID: 30429667 PMCID: PMC6214699 DOI: 10.11613/bm.2018.030502] [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: 02/19/2018] [Accepted: 07/13/2018] [Indexed: 11/06/2022] Open
Abstract
Anisocytosis has been associated with the severity and prognosis of several acute and chronic diseases, as well as physiological conditions such as pregnancy. Anisocytosis is quantified by the red blood cell distribution width (RDW), expressed as the ratio, multiplied by 100, between the standard deviation (SD) of red blood cell volumes and the mean corpuscular volume, or as the SD of erythrocyte volumes (RDW-SD). The aim of the present review was to report the state of the art on the physiological values and the putative diagnostic and prognostic roles of RDW in complicated pregnancy. Literature research for articles published in the last ten years was conducted in Pubmed, Web of Science, ClinicalTrials.gov, and Scopus databases. Abstracts were independently screened by two investigators. If relevant, full articles were retrieved. References, in these articles, citing relevant reviews or original studies were also accessed to identify additional eligible studies. Any disagreement between the reviewers was resolved by a third investigator. A total of 28 studies were included in the review. These studies reported changes in RDW values during physiological pregnancy, and associations between the RDW and several pregnancy complications including anaemia, preeclampsia, gestational diabetes, and recurrent miscarriage. This review provides background information for establishing physiological and pathological RDW values in pregnancy for diagnostic and prognostic use in clinical practice.
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Affiliation(s)
| | - Angelo Zinellu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Arduino A Mangoni
- Department of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Giampiero Capobianco
- Department of Clinical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Salvatore Dessole
- Department of Clinical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Pier Luigi Cherchi
- Department of Clinical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Ciriaco Carru
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
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Gogoi P, Sinha P, Gupta B, Firmal P, Rajaram S. Neutrophil-to-lymphocyte ratio and platelet indices in pre-eclampsia. Int J Gynaecol Obstet 2018; 144:16-20. [PMID: 30362112 DOI: 10.1002/ijgo.12701] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 08/08/2018] [Accepted: 10/24/2018] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To compare the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and platelet indices between women with pre-eclampsia and normotensive pregnant women. METHODS A cross-sectional study conducted from January to July 2017 at a tertiary care hospital in Delhi, India. The study compared pregnant women aged 18-40 years with pre-eclampsia diagnosed at term with healthy pregnant women matched for gestational age. Venous blood samples were drawn and complete blood count was analyzed. The parameters recorded were hemoglobin, red cell distribution width (RDW), platelet count, mean platelet volume (MPV), plateletcrit, and platelet distribution width. RESULTS There were 67 women included in each group. NLR was higher in women with pre-eclampsia compared with the control group (6.8 ± 7.6 vs 3.0 ± 0.98; P=0.001). Both PLR (14.18 ± 14.4 vs 9.54 ± 3.6; P=0.012) and MPV (9.45 ± 1.19 vs 9.02 ± 1.1; P=0.029) were higher in the study group compared with the control group. Platelet count was lower in pre-eclamptic women compared with the control group (188 ± 89.7 vs 200.1 ± 62.36; P=0.014). RDW was also higher in the study group (P=0.025). CONCLUSIONS The present study found that the inflammatory markers NLR, PLR, RDW, and MPV were higher in women with pre-eclampsia. Measuring NLR and PLR may be useful in predicting pre-eclampsia among women at high risk during prenatal follow-up.
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Affiliation(s)
- Priyanka Gogoi
- Department of Pathology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Pallavi Sinha
- Department of Pathology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Bindiya Gupta
- Department of Obstetrics and Gynecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Priyanka Firmal
- Department of Obstetrics and Gynecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Shalini Rajaram
- Department of Obstetrics and Gynecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
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A Ali E, M Abdalla T, Adam I. Platelet distribution width, mean platelet volume and haematological parameters in patients with uncomplicated plasmodium falciparum and P. vivax malaria. F1000Res 2017; 6:865. [PMID: 28794861 PMCID: PMC5538039 DOI: 10.12688/f1000research.11767.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2017] [Indexed: 01/22/2023] Open
Abstract
Background: The association between the haematological profile (including abnormal platelets) and malaria is not completely understood. There are few published data on haematological profiles of malaria patients in areas with unstable malaria transmission. The current study was conducted to investigate if the haematological parameters, including platelet indices, were reliable predictors for microscopically-diagnosed malaria infection. Methods: A case-control study with a total of 324 participants (162 in each arm) was conducted at the out-patient clinic of New Halfa hospital during the rainy and post rainy season (August 2014 through to January 2015). The cases were patients with uncomplicated
Plasmodium falciparum (107; 66.9%) and
P. vivax malaria (55, 34.0%) infections. The controls were aparasitemic individuals. The haematological parameters were investigated using an automated hemo-analyser. Results: There was no significant difference in the mean (±SD) age between the study groups; however, compared to the controls, patients with uncomplicated malaria had significantly lower haemoglobin, leucocyte and platelet counts, and significantly higher red cell distribution width (RDW), platelet distribution width (PDW) and mean platelet volume (MPV). Conclusions: The study revealed that among the haematological indices, PDW and MPV were the main predictors for uncomplicated
P. falciparum and P
. vivax malaria infection
. Abbreviations: OR: odds ratio.
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Affiliation(s)
- Elrazi A Ali
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | | | - Ishag Adam
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
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Yücel B, Ustun B. Neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, mean platelet volume, red cell distribution width and plateletcrit in preeclampsia. Pregnancy Hypertens 2016; 7:29-32. [PMID: 28279444 DOI: 10.1016/j.preghy.2016.12.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 12/18/2016] [Accepted: 12/20/2016] [Indexed: 12/20/2022]
Abstract
INTRODUCTION AND AIM Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), mean platelet volume (MPV), red cell distribution width (RDW) and plateletcrit (PCT) have all been recognized as systemic inflammatory response (SIR) markers. Our aim was to evaluate changes in NLR, PLR, RDW, MPV and PCT in preeclampsia and their use in predicting the severity of PE. STUDY DESIGN This retrospective cohort study included 219 patients. Of them, 27 had mild PE, 82 had severe PE, and 110 were healthy, normotensive pregnant patients. RESULTS There were no significant differences in NLR between the groups (p=0.423). Both PLR and PCT were lower in the patients with severe PE than in the control group, and these differences showed a statistical significance (p=0.007 and p<0.001). On the other hand, both RDW and MPV were statistically higher in the patients with severe PE compared to the control group (p=0.011 and p<0.001). ROC analyzes were used to examine the ability of markers to predict those with severe PE from those with mild PE. Areas under the curve for NLR, PLR and RDW were not statistically significant (p=0.636, 0.104 and 0.36, respectively). For MPV and PCT, the values of area under the curve were 0.641 and 0.712, respectively, and the p values for these parameters statistically differed (p=0.028, p=0.001). CONCLUSION MPV or PCT may be clinical useful markers in the prediction of severe PE. Further, prospective multicenter studies are warranted to better reveal the association between SIR markers and PE.
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Affiliation(s)
- Burak Yücel
- Department of Obstetrics and Gynecology, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey.
| | - Batuhan Ustun
- Department of Obstetrics and Gynecology, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
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Sen-yu W, Chao X. Assessment of the relationship between red blood cell distribution width and preganecy hypertension disease. J Obstet Gynaecol Res 2016; 42:1258-1262. [PMID: 27436585 DOI: 10.1111/jog.13067] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 04/02/2016] [Accepted: 05/02/2016] [Indexed: 12/17/2022]
Affiliation(s)
- Wang Sen-yu
- The Nuclear Medicine Departement; The Second Affiliated Hospital of Xinjiang Medical University; Urumqi China
| | - Xu Chao
- The Clinical Laboratory Department; The 98th Hospital of Chinese PLA; Urumqi China
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Yılmaz ZV, Yılmaz E, Küçüközkan T. Red blood cell distribution width: A simple parameter in preeclampsia. Pregnancy Hypertens 2016; 6:285-287. [PMID: 27939469 DOI: 10.1016/j.preghy.2016.05.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/01/2016] [Accepted: 05/03/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Preeclampsia is a serious disease and a leading cause of maternal and perinatal mortality and morbidity. Red blood cell distribution width (RDW), a measure of anisocytosis, is used as an inflammation marker in hypertension and cardiovascular diseases. Although the relationship between RDW and hypertension has been well documented, the association between preeclampsia and RDW is not clear. We aimed to investigate the relationship between RDW and preeclampsia and its severity. MATERIALS AND METHODS One hundred eighteen pregnant women with preeclampsia and one hundred twenty uncomplicated pregnant women were included in the study. Blood samples for routine CBC and RDW levels were analyzed. RESULTS The RDW values were significantly higher in preeclampsia group compared with the control group (15.23±1.96 vs 14.48±1.70, p<0.05). We also confirmed that RDW levels were significantly higher in severe preeclampsia group than mild preeclampsia group in subgroup analyses (15.08±2.07, 15.92±1.99, p<0.05). CONCLUSION Our study showed that there is an association between RDW and preeclampsia and also its severity. RDW, a marker which is easy, inexpensive and calculated as a part of blood cell count, can be used as a significant diagnostic and prognostic marker in patient with preeclampsia like the other cardiovascular diseases.
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Affiliation(s)
- Zehra Vural Yılmaz
- Dr. Sami Ulus Women's and Children's Health Training and Research Hospital, Department of Obstetrics and Gynaecology Ankara, Turkey.
| | - Elif Yılmaz
- Dr. Sami Ulus Women's and Children's Health Training and Research Hospital, Department of Obstetrics and Gynaecology Ankara, Turkey
| | - Tuncay Küçüközkan
- Dr. Sami Ulus Women's and Children's Health Training and Research Hospital, Department of Obstetrics and Gynaecology Ankara, Turkey
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Heart Rate Variability and Autonomic Modulations in Preeclampsia. PLoS One 2016; 11:e0152704. [PMID: 27043306 PMCID: PMC4820118 DOI: 10.1371/journal.pone.0152704] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Accepted: 03/17/2016] [Indexed: 12/19/2022] Open
Abstract
Background Although the exact pathophysiology of preeclampsia is not well understood, autonomic nervous system imbalance is suggested as one of the main factors. Aims To investigate heart rate variability (HRV) and autonomic modulations in Sudanese pregnant women with preeclampsia. Subjects and Methods A case-control study (60 women in each arm) was conducted at Omdurman Maternity Hospital—Sudan, during the period from June to August, 2014. Cases were women presented with preeclampsia and healthy pregnant women were the controls. Studied groups were matched for important determinants of HRV. Natural logarithm (Ln) of total power (TP), high frequency (HF), low frequency (LF) and very low frequency (VLF) were used to determine HRV. Normalized low and high frequencies (LF Norm and HF Norm) were used to evaluate sympathetic and parasympathetic autonomic modulations respectively. Results Patients with preeclampsia achieved significantly higher LF Norm [49.80 (16.25) vs. 44.55 (19.15), P = 0.044] and LnLF/HF [0.04 (0.68) vs. -0.28 (0.91), P = 0.023] readings, but lower HF Norm [49.08 (15.29) vs. 55.87 (19.56), P = 0.012], compared with healthy pregnant women. Although all other HRV measurements were higher in the patients with preeclampsia compared with the controls, only LnVLF [4.50 (1.19) vs. 4.01 (1.06), P = 0.017] and LnLF [4.01 (1.58) vs. 3.49 (1.23), P = 0.040] reached statistical significance. Conclusion The study adds further evidence for the dominant cardiac sympathetic modulations on patients with preeclampsia, probably secondary to parasympathetic withdrawal in this group. However, the higher LnVLF and LnLF readings achieved by preeclamptic women compared with the controls are unexpected in the view that augmented sympathetic modulations usually depresses all HRV parameters including these two measures.
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Kell DB, Kenny LC. A Dormant Microbial Component in the Development of Preeclampsia. Front Med (Lausanne) 2016; 3:60. [PMID: 27965958 PMCID: PMC5126693 DOI: 10.3389/fmed.2016.00060] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 11/04/2016] [Indexed: 12/12/2022] Open
Abstract
Preeclampsia (PE) is a complex, multisystem disorder that remains a leading cause of morbidity and mortality in pregnancy. Four main classes of dysregulation accompany PE and are widely considered to contribute to its severity. These are abnormal trophoblast invasion of the placenta, anti-angiogenic responses, oxidative stress, and inflammation. What is lacking, however, is an explanation of how these themselves are caused. We here develop the unifying idea, and the considerable evidence for it, that the originating cause of PE (and of the four classes of dysregulation) is, in fact, microbial infection, that most such microbes are dormant and hence resist detection by conventional (replication-dependent) microbiology, and that by occasional resuscitation and growth it is they that are responsible for all the observable sequelae, including the continuing, chronic inflammation. In particular, bacterial products such as lipopolysaccharide (LPS), also known as endotoxin, are well known as highly inflammagenic and stimulate an innate (and possibly trained) immune response that exacerbates the inflammation further. The known need of microbes for free iron can explain the iron dysregulation that accompanies PE. We describe the main routes of infection (gut, oral, and urinary tract infection) and the regularly observed presence of microbes in placental and other tissues in PE. Every known proteomic biomarker of "preeclampsia" that we assessed has, in fact, also been shown to be raised in response to infection. An infectious component to PE fulfills the Bradford Hill criteria for ascribing a disease to an environmental cause and suggests a number of treatments, some of which have, in fact, been shown to be successful. PE was classically referred to as endotoxemia or toxemia of pregnancy, and it is ironic that it seems that LPS and other microbial endotoxins really are involved. Overall, the recognition of an infectious component in the etiology of PE mirrors that for ulcers and other diseases that were previously considered to lack one.
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Affiliation(s)
- Douglas B. Kell
- School of Chemistry, The University of Manchester, Manchester, UK
- The Manchester Institute of Biotechnology, The University of Manchester, Manchester, UK
- Centre for Synthetic Biology of Fine and Speciality Chemicals, The University of Manchester, Manchester, UK
- *Correspondence: Douglas B. Kell,
| | - Louise C. Kenny
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
- Department of Obstetrics and Gynecology, University College Cork, Cork, Ireland
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Elhaj ET, Adam I, Alim A, Elhassan EM, Lutfi MF. Thyroid Function/Antibodies in Sudanese Patients with Preeclampsia. Front Endocrinol (Lausanne) 2015; 6:87. [PMID: 26124747 PMCID: PMC4464070 DOI: 10.3389/fendo.2015.00087] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 05/12/2015] [Indexed: 11/13/2022] Open
Abstract
Preeclampsia is an important cause of maternal and prenatal morbidity and mortality in the developing countries. Changes in thyroid function/antibodies profiles in preeclamptic women are controversial and were never investigated before in Sudan. A case-control study was conducted at Medani Hospital, Sudan, to investigate thyroid function/antibodies in preeclampsia. The sociodemographic, medical history was gathered using questionnaires. Thyroid hormones [thyroid-stimulating hormone (TSH), free tri-iodothyronine (T3), and free thyroxine (T4)] and anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-TG) antibodies were measured using ELISA. The three groups [controls, mild, and severe preeclampsia (SP) (55 women in each arm)] were matched in age and parity. While median (interquartile range) of TSH was significantly lower, both free T3 and free T4 levels were significantly higher in women with preeclampsia than in the healthy controls. There was no significant difference in the TSH levels in women with MP and SP. In comparison with women with MP, women with SP had significantly higher levels of free T3 and significantly lower levels of free T4. While anti-TPO antibodies were significantly higher, anti-TG antibodies were significantly lower in women with preeclampsia. Likewise, anti-TPO antibodies were significantly higher and anti-TG antibodies were significantly lower in women with SP than in women with MP. In linear regression, preeclampsia was significantly associated with TSH (-0.675 IU/ml, P = 0.009), free T3 (0.977 pg/ml, P < 0.001), and free T4 (0.186 ng/dl, P < 0.001) levels. In contrast to anti-TG antibodies and TSH, Sudanese patients with preeclampsia had higher levels of T3 and T4 hormones and anti-TPO antibodies irrespective of parity, gestational age, and hemoglobin levels.
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Affiliation(s)
- Enaam T. Elhaj
- Faculty of Applied Medical Science, Gezira University, Medani, Sudan
| | - Ishag Adam
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
- *Correspondence: Ishag Adam, Faculty of Medicine, University of Khartoum, P.O. Box 102, Khartoum 11111, Sudan,
| | - Ammar Alim
- Faculty of Applied Medical Science, Gezira University, Medani, Sudan
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