Red Cell Parameters Variation in Third Trimester in Normal Pregnancy
Keywords:
Normal pregnancy, third trimester, haematology, physiology
Abstract
Background Haematological profile is considered one of the factors affecting pregnancy and its outcome. The study reported here investigated the variation in some haematological parameters during third trimester of normal pregnancy.Subjects and methods The study reported here is a cross-sectional study of 171 pregnant women in their third trimester who attended a tertiary health centre in India. Full blood count was performed using a Sysmex Hematology, a sixpart auto analyzer able to test all parameters.Results Overall, the values obtained were (mean ± standard deviation [SD]): Red cell mass, 4.222 ± 0.9329 cells/ml; hematocrit level, 34.865 ± 4.299%; hemoglobin concentration, 11.011 ± 1.6399 g/dL; Red cell distribution width, 15.801 ± 3.004%; white blood cells, 10.267 ± 3.102 cells/mm3; cell volume 84.261 ± 9.514 fL, corpuscular hemoglobin, 26.717 ± 3.566 pg; and corpuscular hemoglobin concentration, 31.524 ± 1.640 g/dL; neutrophil count, 68.391 ± 8.610 %; lymphocyte count, 22.080 ± 7.442%; monocyte count, 7.112 ± 4.957%; eosinophil count, 2.547 ± 2.636%. These values were compared with their non-pregnant control values and for correlation p-values were calculated. There was statistically significant association between all parameters except red cell mass and eosinophil count.Conclusion It can be concluded that pregnancy in women alters haematological indices such as haemoglobin, red cell mass, haematocrit, red cell distribution width, red cell indices, total leukocyte counts and differentials. The review highlights that pregnancy is a state characterized by many physiological haematological changes, which may appear to be pathological in the non-pregnant state. DOI: 10.21276/AWCH.1613References
1. Focusing on anaemia: Towards an integrated approach for effective anaemia control. Joint statement by the World Health Organization and the United Nations Children's Fund. World Health Organization 2004. May 10, 2007
2.Antenatal care: routine care for the pregnant woman. National Collaborating Centre for Women's and Children's Health Commissioned by the National Institute for Clinical Excellence Chapter 8, pg 67 – 68. RCOG Press, 27 Sussex Place, Regent's Park, London. May 11, 2007
3. Klebanoff MA, Shiono PH, Selby JV, Trachtenberg AI, Graubard BI: Anemia and spontaneous preterm birth. Am J Obstet Gynecol. 1991, 164 (1): 59-63.
4. Allen LH: Anemia and iron deficiency: effects on pregnancy outcome. Am J Clin Nutr. 2000, 71 (Suppl 5): 1280S-1284S.
5. Meng LZ, Goldenberg RL, Cliver S, Cutter G, Blankson M: The relationship between maternal hematocrit and pregnancy outcome. Obstet Gynecol. 1991, 77: 190-194.
6. Reveiz L, Gyte GML, Cuervo LG: Treatments for iron-deficiency anaemia in pregnancy. Art. No.:CD003094. DOI: 10.1002/14651858.CD003094.pub2. May 10, 2007
7. Bothwell TH, Charlton RW: Iron deficiency in women: a report of the International Nutritional Anemia Consultative Group (INACG). 1981, New York: The Nutrition Foundation
8. K. A. Harrison, “Blood volume changes in normal pregnant Nigerian women,” e Journal of obstetrics and gynaecology of the British Commonwealth, vol. 73, no. 5, pp. 717–723, 1966.
9. R. Yip, “Significance of an abnormally low or high haemoglobin concentration during pregnancy: special consideration of iron nutrition,” e American Journal of Clinical Nutrition, vol. 72, no. 1, pp. 272–279, 2000.
10. G. F. Smith, “An investigation into some of the effects of the state of nutrition of the mother during pregnancy and labour on the condition of the child at birth and for rst few days of life,” Nutrition, vol. 9, no. 4, pp. 388–392, 1993.
11. T. R. James, H. L. Reid, and A. M. Mullings, “Are published standards for haematological indices in pregnancy applicable across populations: an evaluation in healthy pregnant Jamaican women,” BMC Pregnancy and Childbirth, vol. 8, article 8, 2008.
12. I. O. Osonuga, O. A. Osonuga, A. A. Onadeko, A. Osonuga, and A. A. Osonuga, “Hematological pro le of pregnant women in southwest of Nigeria,” Asian Paci c Journal of Tropical Disease, vol. 1, no. 3, pp. 232–234, 2011.
13. J. L. V. Shaw, S. K. Dey, H. O. D. Critchley, and A. W. Horne, “Current knowledge of the aetiology of human tubal ectopic pregnancy,” Human Reproduction Update, vol. 16, no. 4, Article ID dmp057, pp. 432–444, 2010.
14. Centre for Disease Control And Prevention CDC, “Use of supplements containing folic acid among women child beareu age. United states,” 2005.
15. S. M. Garn, M. T. Keating, and F. Falkner, “Hematological status and pregnancy outcomes,” e American Journal of Clinical Nutrition, vol. 34, no. 1, pp. 115–117, 1981.
16. T. S. Imam and A. Yahaya, “Packed cell volume of pregnant women attending Dawakin Kudu General Hospital, Kano State, Nigeria,” Int Jor P App Scs, vol. 2, no. 2, pp. 46–50, 2008.
17. F. Wahed, S. Latif, M. Uddin, and M. Mahmud, “Fact of low hemoglobin and packed cell volume in pregnant women are at a standstill,” Mymensingh Medical Journal, vol. 17, no. 1, pp. 4–7, 2008.
18. Ramsay Margaret (2010) Normal hematological changes during pregnancy and the puerperium. In: Pavord S, Hunt B (eds) The obstetric hematology manual. Cambridge University Press, Cambridge, pp 1–11
19. Bernstein IM, Ziegler W, Badger GJ (2001) Plasma volume expansion in early pregnancy. J Obstet Gynecol 97:669
20. Bjorksten B, Soderstrom T, Damber M-G, von Schoultz B, Stigbrand T (1978) Polymorphonuclear leucocyte function during pregnancy. Scand J Immunol 8(3):257–262
21. Ajzenberg N, Dreyfus M, Kaplan C, Yvart J, Weill B, Tchernia G (1998) Pregnancy-associated thrombocytopenia revisited: assessment and follow-up of 50 cases. Blood 92(12):4573–4580
22. Barriga C, Rodriguez AB, Orega E (1994) Increased phagocyti activity of polymorphonuclear leucocytes during pregnancy. Eu J Obstet Gynecol Reprod Biol 57(1):43–46
23.T. R. James, H. L. Reid, and A. M. Mullings, “Are published standards for haematological indices in pregnancy applicable across populations: an evaluation in healthy pregnant Jamaican women,” BMC Pregnancy and Childbirth, vol. 8, article 8, 2008.
24.World Health Organization. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Geneva: WHO, 2011. Available at: http://apps.who.int/iris/bitstream/10665/85839/3/WHO_NMH_NHD_MNM_11.1_eng.pdf?ua=1
25.Casanova BF, Sammel MD, Macones GA. Development of a clinical prediction rule for iron deficiency anemia in pregnancy. Am J Obstet Gynecol. 2005;193(2):460-6.
26. Shehata HA, Ali MM, Evans-Jones JC, Upton GJ, Manyonda IT; Red cell distribution width (RDW) changes in pregnancy. Int J Gynaecol Obstet. 1998; 62(1): 43-6
27.Fleming AF (1975) Hematological changes in pregnancy. Cli Obstet Gynecol 2:269
28. Gatti L, Tinconi PM, Guarneri D, Bertuijessi C, Ossola MW Bosco P, Gianotti G (1994) Hemostatic parameters and platele activation by flow-cytometry in normal pregnancy: a longitudina study. Internat J Clin Lab Res 24(4):217–219
29. Konijnenberg A, Stokkers E, van der Post J (1997) Extensiv platelet activation in preeclampsia compared with normal preg nancy: enhanced expression of cell adhesion molecules. Am Obstet Gynecol 176(2):461–469
30. Jessica M, Badger F, Hseih CC, Troisi R, Lagiou P, Polischma N (2007) Plasma volume expansion in pregnancy: implication for biomarkers in population studies. Cancer Epidemiol Bio markers 16:1720
31. Karalis L, Nadan S, Yemen EA (2005) Platelet activation pregnancy induced hypertension. Thromb Res 116(5):377–383
32. Kline AJ, Williams GW, Hernandez-Nino J (2005) D-Dime concentration in normal pregnancy: new diagnostic thresholds ar needed. Clin Chem 51(5):825–829
33. Edlestam G, Lowbeer C, Kral G et al (2001) New reference values for routine blood samples and human neutrophilic lipoc alin during third trimester pregnancy. Scand J Clin Lab 61:583–592
34.I. O. Osonuga, O. A. Osonuga, A. A. Onadeko, A. Osonuga, and A. A. Osonuga, “Hematological pro le of pregnant women in southwest of Nigeria,” Asian Paci c Journal of Tropical Disease, vol. 1, no. 3, pp. 232–234, 2011.
35.F. Wahed, S. Latif, M. Uddin, and M. Mahmud, “Fact of low hemoglobin and packed cell volume in pregnant women are at a standstill,” Mymensingh Medical Journal, vol. 17, no. 1, pp. 4–7, 2008.
36. P. Luppi, “How immune mechanisms are affected by pregnancy,” Vaccine, vol. 21, no. 24, pp. 3352–3357, 2003.
2.Antenatal care: routine care for the pregnant woman. National Collaborating Centre for Women's and Children's Health Commissioned by the National Institute for Clinical Excellence Chapter 8, pg 67 – 68. RCOG Press, 27 Sussex Place, Regent's Park, London. May 11, 2007
3. Klebanoff MA, Shiono PH, Selby JV, Trachtenberg AI, Graubard BI: Anemia and spontaneous preterm birth. Am J Obstet Gynecol. 1991, 164 (1): 59-63.
4. Allen LH: Anemia and iron deficiency: effects on pregnancy outcome. Am J Clin Nutr. 2000, 71 (Suppl 5): 1280S-1284S.
5. Meng LZ, Goldenberg RL, Cliver S, Cutter G, Blankson M: The relationship between maternal hematocrit and pregnancy outcome. Obstet Gynecol. 1991, 77: 190-194.
6. Reveiz L, Gyte GML, Cuervo LG: Treatments for iron-deficiency anaemia in pregnancy. Art. No.:CD003094. DOI: 10.1002/14651858.CD003094.pub2. May 10, 2007
7. Bothwell TH, Charlton RW: Iron deficiency in women: a report of the International Nutritional Anemia Consultative Group (INACG). 1981, New York: The Nutrition Foundation
8. K. A. Harrison, “Blood volume changes in normal pregnant Nigerian women,” e Journal of obstetrics and gynaecology of the British Commonwealth, vol. 73, no. 5, pp. 717–723, 1966.
9. R. Yip, “Significance of an abnormally low or high haemoglobin concentration during pregnancy: special consideration of iron nutrition,” e American Journal of Clinical Nutrition, vol. 72, no. 1, pp. 272–279, 2000.
10. G. F. Smith, “An investigation into some of the effects of the state of nutrition of the mother during pregnancy and labour on the condition of the child at birth and for rst few days of life,” Nutrition, vol. 9, no. 4, pp. 388–392, 1993.
11. T. R. James, H. L. Reid, and A. M. Mullings, “Are published standards for haematological indices in pregnancy applicable across populations: an evaluation in healthy pregnant Jamaican women,” BMC Pregnancy and Childbirth, vol. 8, article 8, 2008.
12. I. O. Osonuga, O. A. Osonuga, A. A. Onadeko, A. Osonuga, and A. A. Osonuga, “Hematological pro le of pregnant women in southwest of Nigeria,” Asian Paci c Journal of Tropical Disease, vol. 1, no. 3, pp. 232–234, 2011.
13. J. L. V. Shaw, S. K. Dey, H. O. D. Critchley, and A. W. Horne, “Current knowledge of the aetiology of human tubal ectopic pregnancy,” Human Reproduction Update, vol. 16, no. 4, Article ID dmp057, pp. 432–444, 2010.
14. Centre for Disease Control And Prevention CDC, “Use of supplements containing folic acid among women child beareu age. United states,” 2005.
15. S. M. Garn, M. T. Keating, and F. Falkner, “Hematological status and pregnancy outcomes,” e American Journal of Clinical Nutrition, vol. 34, no. 1, pp. 115–117, 1981.
16. T. S. Imam and A. Yahaya, “Packed cell volume of pregnant women attending Dawakin Kudu General Hospital, Kano State, Nigeria,” Int Jor P App Scs, vol. 2, no. 2, pp. 46–50, 2008.
17. F. Wahed, S. Latif, M. Uddin, and M. Mahmud, “Fact of low hemoglobin and packed cell volume in pregnant women are at a standstill,” Mymensingh Medical Journal, vol. 17, no. 1, pp. 4–7, 2008.
18. Ramsay Margaret (2010) Normal hematological changes during pregnancy and the puerperium. In: Pavord S, Hunt B (eds) The obstetric hematology manual. Cambridge University Press, Cambridge, pp 1–11
19. Bernstein IM, Ziegler W, Badger GJ (2001) Plasma volume expansion in early pregnancy. J Obstet Gynecol 97:669
20. Bjorksten B, Soderstrom T, Damber M-G, von Schoultz B, Stigbrand T (1978) Polymorphonuclear leucocyte function during pregnancy. Scand J Immunol 8(3):257–262
21. Ajzenberg N, Dreyfus M, Kaplan C, Yvart J, Weill B, Tchernia G (1998) Pregnancy-associated thrombocytopenia revisited: assessment and follow-up of 50 cases. Blood 92(12):4573–4580
22. Barriga C, Rodriguez AB, Orega E (1994) Increased phagocyti activity of polymorphonuclear leucocytes during pregnancy. Eu J Obstet Gynecol Reprod Biol 57(1):43–46
23.T. R. James, H. L. Reid, and A. M. Mullings, “Are published standards for haematological indices in pregnancy applicable across populations: an evaluation in healthy pregnant Jamaican women,” BMC Pregnancy and Childbirth, vol. 8, article 8, 2008.
24.World Health Organization. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Geneva: WHO, 2011. Available at: http://apps.who.int/iris/bitstream/10665/85839/3/WHO_NMH_NHD_MNM_11.1_eng.pdf?ua=1
25.Casanova BF, Sammel MD, Macones GA. Development of a clinical prediction rule for iron deficiency anemia in pregnancy. Am J Obstet Gynecol. 2005;193(2):460-6.
26. Shehata HA, Ali MM, Evans-Jones JC, Upton GJ, Manyonda IT; Red cell distribution width (RDW) changes in pregnancy. Int J Gynaecol Obstet. 1998; 62(1): 43-6
27.Fleming AF (1975) Hematological changes in pregnancy. Cli Obstet Gynecol 2:269
28. Gatti L, Tinconi PM, Guarneri D, Bertuijessi C, Ossola MW Bosco P, Gianotti G (1994) Hemostatic parameters and platele activation by flow-cytometry in normal pregnancy: a longitudina study. Internat J Clin Lab Res 24(4):217–219
29. Konijnenberg A, Stokkers E, van der Post J (1997) Extensiv platelet activation in preeclampsia compared with normal preg nancy: enhanced expression of cell adhesion molecules. Am Obstet Gynecol 176(2):461–469
30. Jessica M, Badger F, Hseih CC, Troisi R, Lagiou P, Polischma N (2007) Plasma volume expansion in pregnancy: implication for biomarkers in population studies. Cancer Epidemiol Bio markers 16:1720
31. Karalis L, Nadan S, Yemen EA (2005) Platelet activation pregnancy induced hypertension. Thromb Res 116(5):377–383
32. Kline AJ, Williams GW, Hernandez-Nino J (2005) D-Dime concentration in normal pregnancy: new diagnostic thresholds ar needed. Clin Chem 51(5):825–829
33. Edlestam G, Lowbeer C, Kral G et al (2001) New reference values for routine blood samples and human neutrophilic lipoc alin during third trimester pregnancy. Scand J Clin Lab 61:583–592
34.I. O. Osonuga, O. A. Osonuga, A. A. Onadeko, A. Osonuga, and A. A. Osonuga, “Hematological pro le of pregnant women in southwest of Nigeria,” Asian Paci c Journal of Tropical Disease, vol. 1, no. 3, pp. 232–234, 2011.
35.F. Wahed, S. Latif, M. Uddin, and M. Mahmud, “Fact of low hemoglobin and packed cell volume in pregnant women are at a standstill,” Mymensingh Medical Journal, vol. 17, no. 1, pp. 4–7, 2008.
36. P. Luppi, “How immune mechanisms are affected by pregnancy,” Vaccine, vol. 21, no. 24, pp. 3352–3357, 2003.
Published
2017-08-07
Issue
Section
Original Articles
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access at http://opcit.eprints.org/oacitation-biblio.html).
