Platelet Indices and Antiphospholipid Syndrome in Patients with Recurrent Pregnancy Loss

Main Article Content

Soha Abuelela
Hadeer Shawarby

Abstract

Introduction: Spontaneous pregnancy loss is a common occurrence. Recurrent pregnancy loss (RPL) is defined as two or more failed clinical pregnancies as documented by ultrasonography or histopathologic examination before 20 weeks gestation. Ectopic, molar, and biochemical pregnancies are not included.

Aim: To examine the relationship between platelet indices and the presence of antiphospholipid syndrome (APS) in RPL patients.

Methodology: This study was conducted on fifty first-trimester pregnant females with a history of RPL. Control group included fifty first-trimester pregnant females without history of RPL with at least one live birth. Lupus anticoagulant (LA) testing with simplified dilute Russell’s Viper venom test (DRVVT) and anti-cardiolipin (aCL) antibodies detection with Human Anti-Cardiolipin IgG/IgM ELISA. CBC for mean platelet volume (MPV), Platelet distribution width (PDW), and plateletcrit (PCT) was done for all patients.

Results: The age and the gravida number of the patients were significantly higher than of the control. All platelet indices were significantly higher among RPL group compared to control. According to the positivity of LA and aCL antibodies, RPL patients were classified into 2 groups, 25 patients each, positive and negative for APS respectively. Comparing platelet indices between both subgroups, PCT and MPV were significantly higher among APS positive patients, while PDW did not attain any significance. Receiver operating characteristic (ROC) curve analysis was applied to assess the best cut off value for predicting RPL in patients with APS who may benefit from early treatment.

Conclusion: These low-cost and easily measurable indices can be used for prediction of fetal loss and may help clinicians start early management of high-risk RPL cases.

Keywords:
Plateletcrit, MPV, PDW, antiphospholipid, recurrent pregnancy loss

Article Details

How to Cite
Abuelela, S., & Shawarby, H. (2019). Platelet Indices and Antiphospholipid Syndrome in Patients with Recurrent Pregnancy Loss. Asian Hematology Research Journal, 2(2), 1-7. Retrieved from http://journalahrj.com/index.php/AHRJ/article/view/30103
Section
Original Research Article

References

Macklon NS, Geraedts JPM, Fauser BCJM. Conception to ongoing pregnancy: the “black box” of early pregnancy loss. Hum Reprod Update. 2002;8:333-343.

Practice Committee of American Society for Reproductive Medicine. Definitions of infertility and recurrent pregnancy loss: A committee opinion. Fertil Steril. 2013;99: 63.

Ford HB, Schust DJ. Recurrent pregnancy loss: Etiology, Diagnosis and Therapy. Rev Obstet Gynecol. 2009;2:76-83.

Battinelli EM, Bauer KA. Thrombophilias in pregnancy. Hematol Oncol Clin North Am. 2011;25:323-33.

Miyakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, Cervera R, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost. 2006;4:295-306.

Robertson L, Wu O, Langhorne P, et al. Thrombophilia in pregnancy: A systematic review. Br J Haematol. 2006;132:171-196.

Yilmaz M, Delibas IB, Isaoglu U, et al. Relationship between mean platelet volume and recurrent miscarriage: A preliminary study. Arch Med Sci. 2015; 11,5:989–993.

Chandra S, Tripathi AK, Mishra S, Amzarul M, Vaish AK. Physiological changes in hematological parameters during pregnancy. Indian J Hematol Blood Transfus. 2012;28:144-146.

Aynıoglu O, Isik H, Sahbaz A, et al. Can Plateletcrit be a Marker for Recurrent Pregnancy Loss? Clinical and Applied Thrombosis/Hemostasis. 2016;22:447-452.

Kujovich JL. Thrombophilia and pregnancy complications. Am J Obstet Gynecol. 2004;19:412-424.

Rai R, Regan L. Recurrent miscarriage. Lancet. 2006;368:601-611.

American College of Obstetricians and Gynecologists Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin No. 118: Antiphospholipid syndrome. Obstet Gynecol. 2011;117:192-199.

Rai R, Tuddenham E, Backos M, et al. Thromboelastography, whole-blood haemostasis and recurrent miscarriage. Hum Reprod. 2003;18:2540-2543.

Bates SM, Greer IA, Middeldorp S, Veenstra DL, Prabulos AM, Vandvik PO, et al. VTE, thrombophilia, antithrombotic therapy and pregnancy: Antithrombotic therapy and prevention of thrombosis, 9th ed: American college of chest physicians evidence-based clinical practice guidelines. Chest. 2012;141:e691S-736S.

Van Dreden P, Woodhams B, Rousseau A, Favier M, Favier R. Comparative evaluation of tissue factor and thrombomodulin activity changes during normal and idiopathic early and late foetal loss: The cause of hypercoagulability? Thromb Res. 2012;129:787-792.

Rai R, Shlebak A, Cohen H, Backos M, Holmes Z, Marriott K, et al. Factor V leiden and acquired activated protein C resistance among 1000 women with recurrent miscarriage. Hum Reprod. 2001; 16:961-965.

Kaya MG, Yarlioglues M, Gunebakmaz O, et al. Platelet activation and inflammatory response in patients with non-dipper hypertension. Atherosclerosis. 2010;209: 278-282.

Abdul-Rahman Al-Aghbary A, Almorish M AW, Jaffar DW M, Al-Kahiry WM. Platelet indices in evaluation of patients with recurrent pregnancy loss. Asian Pac J Reprod. 2018;7:15-18.

Meena R, Meena ML, Meena P, Meena R. Association of increased platelet distribution width and red cell distribution width with recurrent pregnancy loss. Int J Reprod Contracept Obstet Gynecol. 2017; 6:1083-1086.

Dundar O, Pektas MK, Bodur S, Bakır LV, Cetin A. Recurrent pregnancy loss is associated with increased red cell distribution width and platelet distribution width. J Obstet Gynaecol Res. 2015;41: 551-558.

Avcıoğlu SN, Altınkaya SÖ, Küçü M, Sezer SD, Yüksel H. The association between platelet indices and clinical parameters in recurrent pregnancy loss. Gynecol Obstet Reprod Med. 2014;20:146-149.

Korkmaz S, Uslu AU, Sahin S, Senel S, Sencan M. Is there a link between mean platelet volume and thrombotic events in antiphospholipid syndrome? Platelets. 2014;25:343-347.

Rupa-Matysek J, Gil L, Wojtasinska E, Ciepluch K, Lewandowska M, Komarnicki M. The relationship between mean platelet volume and thrombosis recurrence in patients diagnosed with antiphospholipid syndrome. Rheumatol Int. 2014;34:1599-1605.

Lood C, Tyden H, Gullstrand B, Nielsen C T, Heegaard, NH H, Linge P, et al. Decreased platelet size is associated with platelet activation and anti-phospholipid syndrome in systemic lupus erythematosus. Rheumatology. 2017;56: 408-416.