ASSESSMENT OF PLATELET COUNT AND PLATELET INDICES IN PREGNANCY INDUCED HYPERTENSION

Sujata N 1 , Shinde P J 2 , Verma A 1 , Ghatge R. M 1 , Gupta S 1 and Inamdar A.A 1 . 1. Post Graduate student, Department of Pathology, D.Y. Patil Medical College, Kolhapur. 2. Associate Professor, Department of Pathology, D.Y. Patil Medical College, Kolhapur. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History

Hypertensive disorders of pregnancy complicate up to 10% of pregnancies worldwide, constituting one of the greatest causes of maternal and perinatal morbidity and mortality. The basic pathology of pregnancy induced hypertension (PIH) is poor placentation, and vasospasm of vessels along with alteration of hematological profile. The study was conducted in Dr. D. Y. Patil Hospital and Research institute, Kolhapur, on 50 patients clinically diagnosed as PIH, and 50 normotensive pregnant women both with gestational age ≥ 20 weeks. In the present study of the 50 PIH cases 22 cases (44%) had severe PIH (diastolic BP ≥110mmHg) and 28 cases (56%) had mild PIH (diastolic BP ≤100mmHg) PIH was found to be common in young primigravidas. Thrombocytopenia was the most common haematological aberration seen in PIH. In the present study thrombocytopenia (<1.5 lakhs) was seen in 12 (24%) of total PIH cases. We made a conclusion that simple and routine tests like CBC with platelet count and platelet indices are highly helpful in suspecting deranged coagulation early in courses of disease and have a crucial role in reducing mortality and morbidity of both mother and fetus.

Introduction:-
Hypertensive disorders of pregnancy, including preeclampsia complicate upto 10% of pregnancies worldwide, constituting one of the greatest causes of maternal and perinatal morbidity and mortality worldwide. The term hypertensive disorders of pregnancy includes a heterogeneous collection of disease complicating pregnancy and form one of the deadly triad along with haemorrhage and infection.
The diagnosis of pregnancy induced hypertension is made in women whose blood pressure reaches 140/90mmHG or greater for first time at ≥ 20 weeks of gestation. Preeclampsia is characterized by hypertension (Blood pressure of 140/90 mmHg or greater), proteinuria (>0.3g/dl), edema and new signs of end organ dysfunction and begins as early as 20 th gestational week. Eclampsia is occurance of seizures in women with preeclmpsia which develops before, during or after labour. 1 The basic pathology of preeclampsia is endothelial dysfunction, poor placentation, and vasospasm of vessels along with alteration of hematological profile 2 . Out of all hematological abnormalities that occur in PIH, thrombocytopenia is the most common seen in 11-29% of patients. These pregnancies also are associated with ISSN: 2320-5407 Int. J. Adv. Res. 5(2), 2067-2071 2068 qualitative changes suggesting increased platelet production and destruction. There is shortened life span, increased number of megakaryocytes in bone marrow and an increase number of immature platelets seen in peripheral smear 4 . Walker J.J. et al showed that in pregnancy induced hypertension there are changes in platelet number, platelet survival and mean platelet volume, which have been interpreted as evidence of increased platelet consumption 9 . The MPV and PDW were elevated proportionally with the severity of pre-eclampsia when compared with the normotensive control group. There is a gradual increase in MPV from normotensive pregnant women to preeclampsia and eclampsia. This increase in MPV in pre-eclampsia and eclampsia probably indicate hyperdestruction of platelets due to shorter platelet half-life 11 . There was an increase in PDW from normotensive pregnant women to pre-eclampsia and eclampsia in the study conducted by Tygart et al. This probability reflects increased platelet turnover which would support the idea that platelet survival time is decreased resulting in increased destruction of platelets 12 . Clinically, platelet indices can be a useful screening test for early identification of pre-eclampsia and eclampsia. Also platelet indices can assess the prognosis of PIH in pregnant women.

Methodology:-
After ethical approval one year prospective study was carried out in D Y Patil Hospital and Research Institute during the period of June 2015 to May 2016. This study was undertaken in Department of Pathology with collaboration of department of Obstetrics and Gynecology, Dr D Y Patil Hospital and Research Institute Kolhapur. The present study includes 50 patients aged 18-35 years clinically diagnosed as pregnancy induced hypertension with gestational age ≥20 weeks attending outpatient department or admitted in antenatal ward/labour room in department of OBG, Dr. D. Y. Patil Hospital and Research institute, Kolhapur. Fifty normotensive pregnant women in the age group of 18-35 years with gestational age ≥20 weeks were included in the control group. CBC valves were determined by Mindray BC-3000 Plus hematology analyser which is a fully automated three part hematology analyser. Platelet count, mean platelet volume(MPV), platelet distribution width(PDW) estimation was compared between the normotensive pregnant women with PIH patients. The statistical analysis used was mean, standard deviation and students t-test. The p value < 0.05 was accepted as significant.

Results:-
PIH is common in young primigravidas, in the present study mean age was 23.8±3.56 years and primigravidas constituted the majority of patients (68%). Thrombocytopenia is the most common haematological aberration seen in PIH. In the present study thrombocytopenia (<1.5 lakhs) was seen in 12 (24%) of total PIH cases. The mean platelet count in mild PIH was 2.23±0.64lacs/cumm and that in severe PIH was 1.67 ±0.55 lacs/cumm. The mean platelet count in normotensive control was 3.14±0.80 lacs/cumm. (

Discussion:-
Women with severe pre-eclampsia develop a variety of hematological aberrations. These hematological aberrations have an impact on the outcome of delivery of these patients so that aggressive therapy can be initiated to prevent maternal and neonatal morbidity and mortality.

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Thrombocytopenia is the most common haematological aberration seen in PIH. . It is caused by increased platelet destruction as shown by decreased platelet lifespan, increased number of megakaryocytes in the bone marrow and an increased proportion of young, oversize platelets (megathrombocytes) in the peripheral blood film. Thrombocytopenia is associated with progressive disease & also with disease severity. Thrombocytopenia occurs in 15% of patients with pre-eclampsia. A significant reduction in platelet count is seen frequently during and even before the onset of disease 13   Severity of PIH and thrombocytopenia are closely correlated which indicates that thrombocytopenia is directly proportional to severity of PIH. The mean platelet count in present study were: 3.14 lacs/cumm in normotensive pregnant women and 2.23 lacs/cumm in mild PIH and 1.67 lacs/cumm in severe PIH cases. When mean platelet count was compared between control and PIH cases, a significant decrease in platelet number was observed and correlated well with the valves of other studies. ( Table No-

Conclusion:-
Pregnancy induced hypertension is the most common complication of pregnancy and remains a leading cause of maternal and fetal morbidity & mortality. As a result of the haemostatic aberrations in PIH, postpartum hemorrhages sometimes so severe as to lead to maternal death may occur. Fetal growth retardation is more frequent in the thrombocytopenic groups. This study gives an outline of the investigations to be done in cases of PIH which can alert the physician of the severity of disease so that appropriate and timely management can be initiated. The estimation of platelet count and platelet indices is a reliable method. In this study an attempt has been made to assess the role of platelet count and platelet indices like MPV and PDW in PIH patients.