Article

Changes and reference intervals of immature granulocytes in the peripheral blood of women according to pregnancy trimester

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Abstract

Background: Immature granulocyte (IG) counts as a powerful clinical parameter can be obtained by new generations of hematology analyzers automatically. Establishment of IG reference intervals in healthy pregnant women is a prerequisite for clinically meaningful interpretation of the parameter. Methods: By using a Sysmex XE-5000 hematology analyzer, a large number of pregnant women comprising 1372 samples were analyzed to determine pregnancy trimester stratified reference intervals for IG, including their absolute values (#IG) and relative values (%IG). Results: Compared with healthy non-pregnant women, #IG and %IG in healthy pregnant women increased significantly (P<0.05). Although there was no difference in #IG and %IG of healthy pregnant women of different ages, these values were positively correlated with pregnancy trimester and there was significant difference among the first, second, and third trimester groups (P<0.05). According to a non-parametric statistical method, the reference intervals for #IG in the first, second, and third trimesters were (0.003-0.091)×109/L, (0.007-0.247)×109/L, and (0.018-0.456)×109/L, respectively, while those for %IG were (0.04-0.92)%, (0.10-2.00)%, and (0.20-3.80)%, respectively. Conclusion: This study demonstrates IG counts in healthy pregnant women increase significantly during pregnancy, especially in the second and third trimesters. IG reference intervals according to pregnancy trimester have been established, and it may be used for evaluating health status of pregnant women and help obstetricians to make their clinical decisions.

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... Thrombocytosis (high platelet count) is caused by acute blood loss (triggers the release of thrombocytes from spleen), chronic myelogenous leukemia (CML), iron deficiency, pregnancy, infection, injury, bone marrow disorder, polycythemia vera, and hyposplenism (missing or malfunctioning spleen) [16,40,52]. Thrombocytopenia (low platelet count) is caused by idiopathic thrombocytopenic purpura, HELLP syndrome, hemolyticuremic syndrome and disseminated intravascular coagulation [5,22,48]. ...
... The leukocytosis-inducing physiological stress is attributed to elevated inflammatory response due to immunomodulation, immunosuppression and selective immune tolerance of fetus. However, Yu et al. [2016] suggests that leukocytosis occurs after normal delivery [9,52]. While Tzur et al. [54] associates leukocytosis in first trimester with complicated pregnancy. ...
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With the advent of many interventions to improve maternal and child health, pregnant women have become the focus of many health programs. However, few data exist regarding this important population. Although pregnancyinduced changes occur in hematological values, very few laboratories provide specific reference ranges for pregnant women. Most laboratory information systems report reference values based on samples obtained from non–pregnant women which may not be useful for clinical decisions during pregnancy. Thus, there is an increased risk of overlooking important physiologic alterations resulting from pathological conditions and of misinterpreting normal changes as pathological events. It is therefore important to understand pregnancy-induced hematological changes for correct clinical evaluation of pregnant women. In this review, we discuss complete blood count and the associated pregnancy-induced hematological changes. We also highlight the dynamic changes of these parameters per trimester and show how they differ between populations.
Article
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