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September 1997, Volume 47, Issue 9

Original Article

Thrombocytopenia in Preeclampsia: An Earlier Detector of HELLP Syndrome

Anila Jaleel  ( Department of Biochemistry, Basic Medical Science Institute, Jinnah Postgraduate Medical Centre, Karachi. )
Abdul Baseer  ( Department of Biochemistry, Basic Medical Science Institute, Jinnah Postgraduate Medical Centre, Karachi. )

Abstract

Platelet count was determined in eighty four pregnant women by direct visual method. Among them thirty normal pregnant women were taken as control. Twenty-seven were preeclamptic and twenty -seven eclamptic women. There was significant (P<0.01) reduction in platelet count of preeclamptic and highly significant (P<0.001) in eclamptic women as compared to controls. It is concluded that there is need to do platelet count in all pregnancy induced hypertensive women, which can be an earlier detector for HELLP syndrome (JPMA 47:230, 1997).

Introduction

Pregnancy induced hypertension is a condition occurring after 20th week of gestation and is diagnosed when two or more of the conditions are present as shown in Table 11-2

Eclampsia is defined as occurrance of convulsions and or Coma in patients with signs and symptoms of preectampsia3-5. Patients with preeclampsia may present the composite picture of thrombocytopenia alongwith abnormal liver functions6. Thrombocytopenia is a term used to describe low platelet count i.e., platelet count less than 100,000/mm36,7. Thrombocytopenia in most patients with preeclampsia is moderately severe, the platelet count usually remains above 50,000/mm38.

The present study was done to see the alterations in platelet counts in patients suffering from pieeclampsia and eclampsia and compare them with controls.

Patients and Methods

Eighty-four pregnant women admitted in obstetrics and gynaecology departments of Civil Hospital and Jinnah Postgraduate Medical Centre, Karachi were included in this study. Thirty had normal pregnancy and fifty-four had pregnancy induced hypertension. Both groups of women (control and patients) were in third trimester of pregnancy. None of the women had received any blood transfusion previously. About 2 ml of blood was drawn from each woman by an aseptic method from the antecubital vein puncture and was kept in a small capped bottle with anticoagulant for assessing platelet count which was estimated by direct visual method using the following formula:

Results

The height, age and gestational age of pregnancy induced hypertensive women and control groups were comparable(Table II).

Weight of eclamptic women was significantly increased (P<0.001) as compared to control group and weight of preeclamptic women was also markedly increased (P<0.01) as compared to normal pregnant women (Table III).

Highly significant (P<0.001) increase in both systolic and diastolic blood pressure was observed in pregnancy induced hypertensive women as compared to controls (Table Ill). Platelet count of preeclamptic women decreased significantly (P<0.01) as compared to controls while in eclamptic women highly significant (P<0.001) decrease in platelet count was observed as compared to normal pregnant women (Table IV).

Discussion

Thrombocytopenia in pregnancy induced hypertensive women may be due to increased consumption of platelets with increased megakaryocytic activity to compensate. Platelets adhere to areas of damaged vascular endothelium resulting in secondary destruction of platelets9,10. Platelets from severely preeclamptic patients showed less response than normal to a variety of aggregating agents suggesting that platelets may have undergone previous aggregation in the microcirculalion. Sonic platelets can aggregate temporarily and after releasing sonic of their active constituents return to the peripheral circulation11. Prostacyclin is an important cicosanoid that exerts strong inhibition of platelet aggregation. There is continuous availability of this cicosanoid from blood vessels which keeps circulating platelets in a dispersed and disaggregated form9 . Deprivation of this prostacyclin makes the circulating platelets even more vulnerable to aggregation. Removal of aggregated platelets might be responsible for thromboc Lopenia ofien observed in pregnancy induced hypertension12. Thus it is concluded from the present study that a low platelet count could be present in pregnancy induced hypertensive women with mild illness, indicating the need to do platelet count in all patients with preeclampsia.

Acknowledgements

I am proud to avail this opportunity to acknowledge the superb help of Al mighty ALLAH for all kindness. I would like to express my sincere appreciation to Dr. Abdul Baseer,
Professor and Head of the Department of Biochemistry BMSI-JPMC for his excellent tutelage, valuable support. moral help and encouragement during the entire period of the research.

References

1. Watson, C.J.E., Thomson, Hi. and Calnes, R. HELLP syndrome, 1t\\\'s not cholecystitis, Br. J Surg., 1990;77:539-40.
2. Chesley. L.C. Diagnosis of pre-eclampsia. Obstet. Gynaecol.. 1 985;65 :423-25
3. Sibai, B.M.. Spirinato. J.A., Watson, D.I. 6 at. Eclampsia. Neurological lindings and future outcome. Am. J. Obstet. Gynaecol., 1985; 152:184-192
4. Guyton, AC. Pregnancy and Lactation in; textbook of medical physiology, Seventh edition, Philadelphia. W.B. Saunders, 1986, PP. 983-95.
5. Gant, N.F.. Chand, S., Worely, R.J et al. A clinical test useful for predicting the development of acute hypertension in pregnancy. Am. J Obstet. Gynescol, 1974;120:1-7.
6. Thiagarajah. S., Bourgeosis, J., Harbert. G.M. et al. Thrombocytopenia in Prceclampsia: Associated abnormalities and management principles Am Obstet. Gynecol.. 1984;150:1-9,
7. Finlayson, N.D.C.. Bouchier, l.A.D. and Richmond, J, Diseases of liver and biliary system In: Davidson principles and practice of medicine, 16th edition, Edwards, C,R W. and Bouchier, I A. D (eds) Edinburgh. Churchill Livingstone. 1993, pp.487-543.
8. Kelton, J.G,, Hunter, D.J.S. and Neame, PB. A platelet function defect in preeclampsia. Obstet. Gynecol., 1 985;65: 107-109.
9. O’Brien, W.F., Saba, HI., Knuppcl, R.A. et al. Alterations in platelet concentration and aggregation in normal pregnancy and preeclampsia. Am. Obstet. Gynecol . 1986;1 55:486-490.
10. Burrows, RE, Hunter, D.J S., Andrew. M. et al. A retrospective study Investigating mechanism of thrombocytopenia in preeclampsia. Obstet. Gyne­col., 1987:70:334-8.
11. Whigham, K.A.E.. Howie, P.W., Drummond, A.H. et al. Abnormal platelet function in Preeclampsia. Br. J. Obstet. Gynecol., 1978;85:28-32.
12. Fitzgerald, D.J., Entman, S.S., Mulloy, K. et al. Decreased Prostacyclin biosynthesis preceding the clinical manifestation of pregnancy-induced hyper­tension Circulation, 1987;75 :956-63.

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