CC BY-NC-ND 4.0 · J Lab Physicians 2019; 11(03): 186-191
DOI: 10.4103/JLP.JLP_161_18
Original Article

Significance of platelet indices as severity marker in nonthrombocytopenic preeclampsia cases

Shilpa Gopal Reddy
Department of Pathology, MVJ Medical College and Research Hospital, Kolar, Karnataka, India
,
Chinaiah Subramanyam Babu Rajendra Prasad
Department of Pathology, Sri Devaraj Urs Medical College, Kolar, Karnataka, India
› Author Affiliations
Financial support and sponsorship Nil.

Abstract

CONTEXT: Preeclampsia is often asymptomatic, and hence, its detection depends on signs or investigations. The platelet (PLT) parameters, in cases of preeclampsia with normal PLT count, are seldom analyzed. Hence, this study was undertaken to study the PLT parameters in nonthrombocytopenic preeclampsia cases.

AIM: The aim was to evaluate the use of PLT indices as severity markers in nonthrombocytopenic preeclampsia cases.

SUBJECTS AND METHODS: This prospective study was done on 120 cases of severe preeclampsia, 115 cases of preeclampsia without severe features, and 203 normal pregnant women admitted in the obstetrics wards during the study period of 1 year. The PLT indices obtained by analyzing anticoagulated blood were recorded.

STATISTICAL ANALYSIS USED: Analysis of variance test was used to see the significance of association. Receiver operating characteristic (ROC) curve and binary regression analysis was used to estimate the cutoff value and examine the predictive value of the PLT parameters in the disease progression of preeclampsia.

RESULTS: Even in the absence of thrombocytopenia, mean platelet volume (MPV) and PLT distribution width were significantly higher in severe preeclampsia group (P < 0.001) and were also positively correlating with mean arterial pressure (r = 0.38 and 0.20, respectively). ROC curve analysis showed that MPV had the highest area under the curve of 0.78 (95% confidence interval [0.719‒0.842]). Cutoff value of >10.95 fl for MPV was found to have significant predictive value for disease progression in preeclampsia.

CONCLUSIONS: Even in the absence of thrombocytopenia, PLT indices, especially MPV, have a good diagnostic significance in detecting severe preeclampsia. Further studies are required to evaluate their role as biomarkers in preeclampsia.



Publication History

Received: 03 December 2018

Accepted: 31 May 2019

Article published online:
07 April 2020

© 2019.

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 
  • References

  • 1 Sibai BM. Diagnosis and management of gestational hypertension and preeclampsia. Obstet Gynecol 2003;102:181-92.
  • 2 Juan P, Stefano G, Antonella S, Albana C. Platelets in pregnancy. J Prenat Med 2011;5:90-2.
  • 3 Mohapatra S, Pradhan BB, Satpathy UK, Mohanty A, Pattnaik JR. Platelet estimation: Its prognostic value in pregnancy induced hypertension. Indian J Physiol Pharmacol 2007;51:160-4.
  • 4 Leeman L, Dresang LT, Fontaine P. Hypertensive disorders of pregnancy. Am Fam Physician 2016;93:121-7.
  • 5 Freitas LG, Alpoim PN, Komatsuzaki F, Carvalho Md, Dusse LM. Preeclampsia: Are platelet count and indices useful for its prognostic? Hematology 2013;18:360-4.
  • 6 Redman CW. Platelets and the beginnings of preeclampsia. N Engl J Med 1990;323:478-80.
  • 7 Hutt R, Ogunniyi SO, Sullivan MH, Elder MG. Increased platelet volume and aggregation precede the onset of preeclampsia. Obstet Gynecol 1994;83:146-9.
  • 8 Yang SW, Cho SH, Kwon HS, Sohn IS, Hwang HS. Significance of the platelet distribution width as a severity marker for the development of preeclampsia. Eur J Obstet Gynecol Reprod Biol 2014;175:107-11.
  • 9 American College of Obstetricians and Gynecologists, Task Force on Hypertension in Pregnancy. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists, Task Force on Hypertension in Pregnancy. Obstet Gynecol 2013;122:1122-31.
  • 10 Dundar O, Yoruk P, Tutuncu L, Erikci AA, Muhcu M, Ergur AR, et al. Longitudinal study of platelet size changes in gestation and predictive power of elevated MPV in development of pre-eclampsia. Prenat Diagn 2008;28:1052-6.
  • 11 Moran P, Davison JM. Clinical management of established pre-eclampsia. Baillieres Best Pract Res Clin Obstet Gynaecol 1999;13:77-93.
  • 12 Chu SG, Becker RC, Berger PB, Bhatt DL, Eikelboom JW, Konkle B, et al. Mean platelet volume as a predictor of cardiovascular risk: A systematic review and meta-analysis. J Thromb Haemost 2010;8:148-56.
  • 13 Uzan J, Carbonnel M, Piconne O, Asmar R, Ayoubi JM. Pre-eclampsia: Pathophysiology, diagnosis, and management. Vasc Health Risk Manag 2011;7:467-74.
  • 14 Redman CW, Sargent IL. Latest advances in understanding preeclampsia. Science 2005;308:1592-4.
  • 15 von Dadelszen P, Magee LA, Devarakonda RM, Hamilton T, Ainsworth LM, Yin R, et al. The prediction of adverse maternal outcomes in preeclampsia. J Obstet Gynaecol Can 2004;26:871-9.
  • 16 Howarth S, Marshall LR, Barr AL, Evans S, Pontre M, Ryan N. Platelet indices during normal pregnancy and pre-eclampsia. Br J Biomed Sci 1999;56:20-2.
  • 17 Han L, Liu X, Li H, Zou J, Yang Z, Han J, et al. Blood coagulation parameters and platelet indices: Changes in normal and preeclamptic pregnancies and predictive values for preeclampsia. PLoS One 2014;9:e114488.
  • 18 Vagdatli E, Gounari E, Lazaridou E, Katsibourlia E, Tsikopoulou F, Labrianou I. Platelet distribution width: A simple, practical and specific marker of activation of coagulation. Hippokratia 2010;14:28-32.
  • 19 Kim MA, Han GH, Kwon JY, Kim YH. Clinical significance of platelet-to-lymphocyte ratio in women with preeclampsia. Am J Reprod Immunol 2018;80:e12973.
  • 20 Mannaerts D, Heyvaert S, De Cordt C, Macken C, Loos C, Jacquemyn Y. Are neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and/or mean platelet volume (MPV) clinically useful as predictive parameters for preeclampsia? J Matern Fetal Neonatal Med 2019;32:1412-9.
  • 21 Abdel RM, Mostafa A, Taha S, Salah A. Combined doppler ultrasound and platelet indices for prediction of preeclampsia in high-risk pregnancies. J Matern Fetal Neonatal Med 2018; 24:1-5.
  • 22 Calvert SM, Tuffnell DJ, Haley J. Poor predictive value of platelet count, mean platelet volume and serum urate in hypertension in pregnancy. Eur J Obstet Gynecol Reprod Biol 1996;64:179-84.
  • 23 Makuyana D, Mahomed K, Shukusho FD, Majoko F. Liver and kidney function tests in normal and pre-eclamptic gestation — A comparison with non-gestational reference values. Cent Afr J Med 2002;48:55-9.
  • 24 Myatt L, Clifton RG, Roberts JM, Spong CY, Hauth JC, Varner MW, et al. First-trimester prediction of preeclampsia in nulliparous women at low risk. Obstet Gynecol 2012;119:1234-42.
  • 25 Ceyhan T, Beyan C, Başer I, Kaptan K, Güngör S, Ifran A. The effect of pre‑eclampsia on complete blood count, platelet count and mean platelet volume. Ann Hematol 2006;85:320-2.
  • 26 Park Y, Schoene N, Harris W. Mean platelet volume as an indicator of platelet activation: Methodological issues. Platelets 2002;13:301-6.
  • 27 Lancé MD, van Oerle R, Henskens YM, Marcus MA. Do we need time adjusted mean platelet volume measurements? Lab Hematol 2010;16:28-31.
  • 28 Acestor N, Goett J, Lee A, Herrick TM, Engelbrecht SM, Harner‑Jay CM, et al. Towards biomarker‑based tests that can facilitate decisions about prevention and management of preeclampsia in low‑resource settings. Clin Chem Lab Med 2016;54:17‑27.