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Blood coagulation parameters and platelet indices: changes in normal and preeclamptic pregnancies and predictive
Lei Han1, Xiaojie Liu2, Hongmei Li2
1Department of Obstetrics and Gynecology, Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, P.R.China; Department of Obstetrics and Gynecology, the 306th Hospital of the Chinese People's Liberation Army, Beijing, P.R.China.
Insights
Thrombin time and mean platelet volume can predict preeclampsia (PE) onset and severity. These blood coagulation and platelet indices offer valuable insights for monitoring this high-risk obstetric condition.
Area of Science:
- Obstetrics and Gynecology
- Hematology
- Clinical Pathology
Background:
- Preeclampsia (PE) is a significant obstetric disorder with high morbidity and mortality.
- The exact cause of PE remains unclear, but coagulation-fibrinolysis system dysfunction is a key feature.
- Identifying reliable predictors for PE onset and severity is crucial for timely intervention.
Purpose of the Study:
- To investigate blood coagulation parameters and platelet indices as potential predictors for PE.
- To assess the diagnostic and prognostic value of these markers in different stages and severities of PE.
Main Methods:
- Blood samples were collected from normal pregnant women and those with mild (mPE) and severe preeclampsia (sPE).
- Coagulative parameters and platelet indices were measured and compared across groups during early and late pregnancy.
- Receiver-operating characteristic (ROC) curves and binary regression analysis were used to evaluate predictive values.
Main Results:
- Normal pregnancy exhibits a physiological hypercoagulable state in late pregnancy.
- PE patients showed elevated activated partial thromboplastin time (APTT), thrombin time (TT), mean platelet volume (MPV), and D-dimer (DD) in the third trimester.
- Thrombin time (TT) demonstrated the highest predictive value for PE onset (AUC=0.743), while MPV was most effective for predicting PE severity (AUC=0.671).
Conclusions:
- Normal pregnancy induces a hypercoagulable state, which is altered in PE.
- PE is associated with complex coagulation pathway disorders, leading to platelet and fibrinogen consumption.
- Thrombin time (TT) and mean platelet volume (MPV) show promise as early monitoring markers for PE onset and severity, respectively.
Background:
Preeclampsia (PE) is an obstetric disorder with high morbidity and mortality rates but without clear pathogeny. The dysfunction of the blood coagulation-fibrinolysis system is a salient characteristic of PE that varies in severity, and necessitates different treatments. Therefore, it is necessary to find suitable predictors for the onset and severity of PE.
Objectives:
We aimed to evaluate blood coagulation parameters and platelet indices as potential predictors for the onset and severity of PE.
Methods:
Blood samples from 3 groups of subjects, normal pregnant women (n = 79), mild preeclampsia (mPE) (n = 53) and severe preeclampsia (sPE) (n = 42), were collected during early and late pregnancy. The levels of coagulative parameters and platelet indices were measured and compared among the groups. The receiver-operating characteristic (ROC) curves of these indices were generated, and the area under the curve (AUC) was calculated. The predictive values of the selected potential parameters were examined in binary regression analysis.
Results:
During late pregnancy in the normal pregnancy group, the activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT) and platelet count decreased, while the fibrinogen level and mean platelet volume (MPV) increased compared to early pregnancy (p<0.05). However, the PE patients presented with increased APTT, TT, MPV and D-dimer (DD) during the third trimester. In the analysis of subjects with and without PE, TT showed the largest AUC (0.743) and high predictive value. In PE patients with different severities, MPV showed the largest AUC (0.671) and ideal predictive efficiency.
Conclusion:
Normal pregnancy causes a maternal physiological hypercoagulable state in late pregnancy. PE may trigger complex disorders in the endogenous coagulative pathways and consume platelets and FIB, subsequently activating thrombopoiesis and fibrinolysis. Thrombin time and MPV may serve as early monitoring markers for the onset and severity of PE, respectively.
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