The Capacity of RDW and Platelet indices in defining Pre-eclampsia severity: A cases-control study
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... ng/mL, whereas athletes with SF had a mean concentration of 3.5±5.1 ng/mL [28]. ERFE concentrations in healthy pregnant women remain significantly lower than those of elite male and female athletes [28][29][30][31] or individuals with erythropoietic stress-inducing disorders [32][33][34][35]. Finally, additional research is necessary to determine the relationship between the iron status of the neonate and the ERFE of the mother [36]. ...
Background: It is estimated that more than half of pregnant women all over the world are anemic. The potential of erythroferrone (ERFE) and growth differentiation factor-15 (GDF15) as indicators for iron deficiency could be used to detect various types of anemia, cardiovascular and metabolic diseases. Objectives: To assess whether variations in erythroferrone and Growth Differentiation Factor-15 in blood levels among pregnant women might be used as a marker for anemia. Methods: A cross-sectional study recruited 120 pregnant women into a study group: 60 anemic pregnant women and 60 healthy pregnant controls. Their demographics, hematological indices, and biomarkers (growth differentiation factor-15, erythroferrone, serum ferritin and iron) were collected. Results: It has been found that anemic pregnant women have statistically higher levels of Growth Differentiation-15, Erythroferrone, and other iron status compared to healthy pregnant women. The average concentration of ERFE in anemic pregnant women was 5.6 ng/mL, while in healthy pregnant women, it was 2.2 ng/mL. For GDF-15, the average concentration was 457.27 pg/mL for anemic patients and 228.89 pg/mL for healthy pregnant women. The cutoff value of both GDF-15 and ERFE had the highest sensitivity and specificity in differentiating anemic pregnant women, 1.000 (p<0.0001) for the area under the curve in the case of healthy controls. Conclusions: The markers erythroferrone and GDF-15 have a significant correlation with iron indicators and are recommended for screening anemic pregnant women.
... Since preeclampsia imposes severe complications for the mother and her unborn fetus, appropriate screening and risk assessment are indispensable [32] [41,42]. ...
Sickle cell disease (SCD) is a widespread disease caused by a mutation in the beta-globin gene that leads to the production of abnormal hemoglobin called hemoglobin S. The inheritance of the mutation could be homozygous or heterozygous combined with another hemoglobin mutation. SCD can be characterized by the presence of dense, sickled cells that causes hemolysis of blood cells, anemia, painful episodes, organ damage, and in some cases death. Early detection of SCD can help to reduce the mortality and manage the disease effectively. Therefore, different techniques have been developed to detect the sickle cell disease and the carrier states with high sensitivity and specificity. These techniques can be screening tests such as complete blood count, peripheral blood smears, and sickling test; confirmatory tests such as hemoglobin separation techniques; and genetic tests, which are more expensive and need to be done in centralized labs by highly skilled personnel. However, advanced portable point of care techniques have been developed to provide a low-cost, simple, and user-friendly device for detecting SCD, for instance coupling solubility tests with portable devices, using smartphone microscopic classifications, image processing techniques, rapid immunoassays, and sensor-based platforms. This review provides an overview of the current and emerging techniques for sickle cell disease detection and highlights the different potential methods that could be applied to help the early diagnosis of SCD.
Platelet indices as predictors of fetal growth restriction in Pre-eclamptic Women
Nori W, Roomi AB, Akram W. Platelet indices as predictors of fetal growth restriction in Pre-eclamptic Women . Revista Latinoamericana de Hipertensión. 2020;15(4): 280-285 http://doi.org/10.5281/zenodo.4442971
Abstract
Objectives: Preeclampsia PE is a mysterious syndrome implicating maternal and fetal well-being; fetal growth restriction is one of its complications. This study links platelet indices observed in pre-eclampsia women and fetal growth restriction in 34 weeks of pregnancy.
Methods: A cross-sectional study enrolled 33 consented patients over one year. All participants were severe PE cases; we recorded the mean blood pressure for all. From blood samples, we estimated platelet distribution width and mean platelet volume. An ultrasound and Doppler measurements evaluated the fetal birth weight and amniotic fluid index, the pulsatility index, and the resistance index (PI & RI).
Result: Analysis showed a mean platelet volume of 9.4 ± 0.29 fL, platelet distribution width of 17.7 ± 1.1 fL. The ultrasound showed an amniotic fluid index of 6.34 ± 26 cm and a 30.81 ± 14.4% fetal weight percentile. Doppler indices, including the umbilical arteries' resistance index & pulsatility index, were 3.73 ± 15.93 and 2.52 ± 0.37, respectively. A correlation was found between the platelet distribution width and the pulsatility index by the coefficient of mallows. A platelet distribution width higher than the 75th percentile showed an Odd ratio of 16)CI of 1.79 to 14.3(, P<0.01 for predicting a growth-restricted fetus. In an amniotic fluid volume <5 cm, an Odd ratio of 9)CI of 1.19 – 7.3(, P<0.03 for a growth-restricted fetus prediction.
Conclusion: Platelet distribution width can serve as a good predictor of growth restriction in pre-eclamptic mothers along with amniotic fluid index & PI.
Keywords: Preeclampsia, fetal growth restriction, Platelet indices, platelet distribution width, mean platelet volume.
Background:
A study has been performed in overweight and obese subjects to assess the effects of adiposity and inflammation indicators on dysmetabolic biomarkers via red cell distribution width (RDW) and mean corpuscular volume (MCV), taking into account pro-antioxidant balance.
Methods:
Data from 166 overweight subjects were analyzed by a path analysis model using structural equation modelling (SEM) to evaluate the direct and indirect pathway effects of adiposity, measured by body mass index (BMI) and waist circumference (WC), and inflammation status, measured by pro-antioxidant balance [reactive oxygen species (ROS)], lag-time and slope and C-reactive protein (CRP) values on dysmetabolic biomarkers, via RDW and MCV.
Results:
BMI was strongly linked to CRP and ROS levels. Moreover, there was a significant negative decrease of MCV (1.546 femtoliters) linked to BMI indirectly via high CRP levels. Furthermore, WC affected RDW, indicating a possible mediatory role for RDW in relation to the relationship between WC and homeostatic model assessment (HOMA), insulin and high density lipoprotein (HDL), respectively. This was evident by the elevated HOMA and insulin levels and the decreased levels of HDL. Finally, ROS-related markers did not affect directly RDW and MCV.
Conclusion:
The reported outcomes suggest that RDW might play a mediatory role in the relationship between WC and the dysmetabolic outcomes in overweight and obese individuals. CRP seems to modulate the linkage between BMI and MCV. This study provides the backbone structure for future scenarios and lays the foundation for further research on the role of RDW and MCV as suitable biomarkers for the assessment of cardiovascular disease (HDL-cholesterol), inflammatory bowels and insulin resistance.
Background:
The hypochromic microcytic anemia (HMA) commonly found in Thailand are iron deficiency anemia (IDA) and thalassemia trait (TT). Accurate discrimination between IDA and TT is an important issue and better methods are urgently needed. Although considerable RBC formulas and indices with various optimal cut-off values have been developed, distinguishing between IDA and TT is still a challenging problem due to the diversity of various anemic populations. To address this problem, it is desirable to develop an improved and automated prediction model for discriminating IDA from TT.
Methods:
We retrospectively collected laboratory data of HMA found in Thai adults. Five machine learnings, including k-nearest neighbor (k-NN), decision tree, random forest (RF), artificial neural network (ANN) and support vector machine (SVM), were applied to construct a discriminant model. Performance was assessed and compared with thirteen existing discriminant formulas and indices.
Results:
The data of 186 patients (146 patients with TT and 40 with IDA) were enrolled. The interpretable rules derived from the RF model were proposed to demonstrate the combination of RBC indices for discriminating IDA from TT. A web-based tool 'ThalPred' was implemented using an SVM model based on seven RBC parameters. ThalPred achieved prediction results with an external accuracy, MCC and AUC of 95.59, 0.87 and 0.98, respectively.
Conclusion:
ThalPred and an interpretable rule were provided for distinguishing IDA from TT. For the convenience of health care team experimental scientists, a web-based tool has been established at http://codes.bio/thalpred/ by which users can easily get their desired screening test result without the need to go through the underlying mathematical and computational details.
Recently, the diagnostic criteria of preeclampsia have been changed. No studies are available in the literature that analyzed in detail the differences between early-onset preeclampsia (EOP) and late-onset preeclampsia (LOP), taking into account the International Society for the Study of Hypertension in Pregnancy (ISSHP) criteria. Thus, we sought to retrospectively investigate in detail the differences in clinical and laboratory outcomes between EOP and LOP diagnosed according to the ISSHP criteria. A retrospective cohort study was conducted in 214 women with singleton pregnancies and preeclampsia admitted to the Department of Obstetrics and Perinatology of the University Hospital in Kraków, Poland, from 2013 to 2017 (113 (52.8%) women with EOP and 101 (47.2%) women with LOP). Electronic medical records were reviewed for demographics and medical history, laboratory tests, and delivery and neonatal data. Patients with preeclampsia accounted for 1.7% of the women who delivered during the study period. The EOP and LOP groups did not differ in the distribution of risk factors for preeclampsia. The most common risk factor was primiparity, which was observed in 72.0% of cases. Regarding the ISSHP diagnostic criteria, the two groups differed in the incidence of fetal growth restriction (p=0.0009), hemolysis (p=0.0416), and neurological complications (p=00342), which were found more often in the EOP group. In addition, the EOP group had more frequent occurrence of severe cardiorespiratory (p
Preeclampsia (PE) is characterised by the new onset of hypertension after the 20th week of pregnancy, with or without proteinuria or hypertension that leads to end-organ dysfunction. Since the only definitive treatment is delivery, PE still represents one of the leading causes of preterm birth and perinatal mobility and mortality. Therefore, any strategies that aim to reduce adverse outcomes are based on early primary prevention, prenatal surveillance and prophylactic interventions. In the last decade, intense research has been focussed on the study of predictive models in order to identify women at higher risk accurately. To date, the most effective screening model is based on the combination of anamnestic, demographic, biophysical and maternal biochemical factors. In this review, we provide a detailed discussion about the current and future perspectives in the field of PE. We will examine pathogenesis, risk factors and clinical features. Moreover, recent developments in screening and prevention strategies, novel therapies and healthcare management strategies will be discussed.
Introduction:
Status epilepticus (SE) in pregnancy represents a life-threatening medical emergency for both mother and fetus. Pregnancy-related pharmacokinetic modifications and the risks for fetus associated with the use of antiseizure medications (ASMs) and anesthetic drugs complicate SE management. No standardized treatment protocol for SE in pregnancy is available to date.
Areas covered:
In this review, we provide an overview of the current literature on the management of SE in pregnancy and we propose a multidisciplinary-based protocol approach.
Expert opinion:
Literature data are scarce (mainly anecdotal case reports or small case series). Prompt treatment of SE during pregnancy is paramount and a multidisciplinary team is needed. Benzodiazepines are the drugs of choice for SE in pregnancy. Levetiracetam and phenytoin represent the most suitable second-line agents. Valproic acid should be administered only if other ASMs failed and preferably avoided in the first trimester of pregnancy. For refractory SE, anesthetic drugs are needed, with propofol and midazolam as preferred drugs. Magnesium sulphate is the first-line treatment for SE in eclampsia. Termination of pregnancy, via delivery or abortion, is recommended in case of failure of general anesthetics. Further studies are needed to identify the safest and most effective treatment protocol.
Red cell distribution width (RDW), a measure of variation in red blood cell size, is routinely reported in the results of a complete blood count. Recent studies have found that RDW is a predictor of high cardiovascular morbidity and mortality. Furthermore, previous cross-sectional studies have shown a possible association between high RDW and hypertension. However, the longitudinal relationship between high RDW and incident hypertension is uncertain. The aim of this study was to investigate the association between RDW and the development of hypertension. In this retrospective cohort study, we analyzed 124,261 participants without hypertension at baseline who underwent two health checkups at 4-year intervals from 2005 to 2016. The subjects were divided into quartiles (Q1–Q4) according to their baseline RDW levels. Multivariate logistic regression was used to estimate the OR and 95% CI for the development of hypertension after 4 years. After 4 years, 6827 cases (5.5%) of incident hypertension were observed. The incidence rates of hypertension were 4.66%, 5.66%, 5.99%, and 5.46% for Q1, Q2, Q3 and Q4 of RDW, respectively. The ORs (95% CIs) for incident hypertension compared with Q1 were 1.19 (1.10–1.29), 1.28 (1.18–1.39), and 1.32 (1.22–1.44) for Q2, Q3, and Q4 of RDW, respectively. High RDW was significantly and independently associated with the development of hypertension in Korean adults. Further research is warranted to verify the mechanism underlying this relationship.