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Association Between Complete Blood Count Components and Intrahepatic Cholestasis of Pregnancy
Jessica Silva1, Melissa Magenta1, Giovanni Sisti1
1Department of Obstetrics and Gynecology, New York Health and Hospitals/Lincoln, Bronx, USA.
Insights
Routine blood count markers, including white blood cells (WBC) and neutrophil-to-lymphocyte ratio (NLR), may help diagnose intrahepatic cholestasis of pregnancy (ICP). Lower WBC and NLR levels in the third trimester were associated with ICP.
Area of Science:
- Obstetrics and Gynecology
- Hematology
- Reproductive Medicine
Background:
- Inflammatory markers like neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are recognized biomarkers for obstetric conditions such as preeclampsia.
- The potential role of these complete blood count (CBC) components and ratios in diagnosing intrahepatic cholestasis of pregnancy (ICP) remains underexplored.
Purpose of the Study:
- To investigate the association between routine complete blood count (CBC) parameters and their ratios with intrahepatic cholestasis of pregnancy (ICP).
- To evaluate if CBC components and ratios can serve as potential biomarkers for ICP diagnosis.
Main Methods:
- A retrospective case-control study was conducted comparing 33 pregnancies with ICP to 33 matched healthy pregnancies.
- White blood cells (WBC), hemoglobin, neutrophils, lymphocytes, NLR, PLR, platelets, red cell distribution width (RDW), and mean platelet volume (MPV) were analyzed in the first and third trimesters.
- Comparisons were also made between mild and severe ICP cases based on serum total bile acid (TBA) levels in the third trimester.
Main Results:
- No significant differences in CBC parameters were observed between ICP cases and controls in the first trimester.
- In the third trimester, women with ICP showed decreased white blood cells (WBC), neutrophil counts, and neutrophil-to-lymphocyte ratio (NLR) compared to controls.
- Mean platelet volume (MPV) was significantly higher in the third trimester for ICP patients, while RDW was lower in mild ICP compared to severe ICP.
Conclusions:
- Decreased WBC, neutrophil counts, NLR, and altered MPV levels in the third trimester are associated with intrahepatic cholestasis of pregnancy (ICP).
- These CBC-derived markers may potentially augment the diagnostic criteria for ICP.
- Further research is warranted to elucidate the underlying molecular mechanisms.
Abstract:
Objective Some components of the routine complete blood count (CBC) and their ratios, such as neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been found to be sensitive biomarkers of preeclampsia and other inflammatory obstetric conditions. We wanted to evaluate whether they can be associated with intrahepatic cholestasis of pregnancy (ICP). Materials and Methods We conducted a retrospective case-control study between May 1, 2015 and July 1, 2018. Cases were considered pregnancies with ICP and control healthy pregnancies. Cases and controls were matched for age, parity, and race. We compared the levels of white blood cells (WBC), hemoglobin, neutrophils, lymphocytes, NLR, PLR, platelets, red cell distribution width (RDW), and mean platelet volume (MPV) in the first and third trimesters between cases and controls. In addition, we compared the same components in the third trimester between patients with mild (serum total bile acid (TBA) of 10 - 40 µmols/L) and severe (TBA > 40 µmols/L) ICP. Results There were 33 patients with ICP and 33 controls. There were no significant differences between the two groups in the first trimester. WBC, neutrophil count, and NLR were decreased in women with ICP in the third trimester compared to controls. MPV was significantly higher in the third trimester of patients with ICP compared to controls. RDW was lower in mild ICP compared to severe ICP in the third trimester. Conclusion Decreased WBC, neutrophil, NLR, and MPV values are associated with ICP and may be useful additions to the diagnostic algorithm for ICP. Larger studies are needed to assess the responsible underlying molecular pathogenic mechanisms.
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