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Erythrocyte aggregability in normal pregnancy and preeclampsia
S100 326
SPO Abstracts
J a n u a r y 1997 A m J O b s t e t Gynecol
ERYTHROUYrE AGGREGABILITY IN NORMAL PREGNANCY AND PREECLAMPSIA. D. Mankuta ~, A. P~ibustg, D. Meyerstein ~, M. Katz, N. Meyerstein ~. Dept. O b / G y n Soroka Med. Center, The Dr Kaufmann Hematology Lab Dept. Physiology, Chemistry Dept., Ben Gurioo University, Beer Sheva Israel. OBJECTIVE: The aim of this study was to examine the eiwtfirocyte aggregability and blood admittance of normal pregnant women and preeclamptic patients. STUDY DESIGN: The aggregability and admittance of 78 samples were quantified by a new method based upon the blood dielectric properties. In addition, the concentration of plasma proteins, Na + and K + levels and hematocrit (Hct) were assessed. The effect of low molecular weight dextran on the aggregability was exanfined. RESULTS: There were altered aggregability and blood admittance in both normal pregnancy and preeclamptie women compared with the control group. These changes rise with the duration of pregnancy and do not depend on variations in Hct and plasma composition (i.e., fibrinogen, albuinin sodium and potassimn levels). The aggregability and admittance of blood of normal pregnant women ditti~r from these parameters in preeclainpsia. The addition of low molecular weight dextran to blood samples partially reverts changes in the aggregability and blood admittance. The aggregability reaches nearly normal value when dextran concentration is lower than that used in clinical practice. CONCLUSIONS: E~3,throeyte aggregability and the blood admittance correlate with the duration of pregnancy. These indices for normal and preeelamptic women are different. The addition of low molecular weight dextran reverts aggregability up to nearly normal values. This finding suggests a way to correct in vitro aggregability in preeclampsia.
328
PREECLAMPSIA (PE) IS FOLLOWED BY SUBCLINICAL ABNORMALITIES IN VOLUME HOMEOSTASIS (VIt) AND RENAL HEMODYNAMICS (RH). E. van BeeU, 7". Ekha~?, P.W. de Leeuw% L.L.H. Peeters. Dept. Ob./Gyn. and Int. Med. #, Acadenaic Hospital Maasticht, Maastricht, The Netherlands. OBJECTIVE: Essential Hypertension (HT) is preceded by latent abnormalities in VH and RH (N Engl J Med 1991;324:1305-11). About 40% of ex-preeelamptics (ex-PE) are known to have HT. In this smdy we evaluated whether or not latent abnormalities in VH and RH are confined to H T subjects. STUDY DESIGN: ~'(e measured > 5 months postpartum after either a normal pregnancy (controls, n - 12) or a pregnancy complicated by PE (n - 25), the MAP (Dinamap), effective renal plasnla flow and glomerular filtration rate (ERPF and GFR, PAIl and inulin clearances), plasma volume (PV in m l / k g lean body mass, t2%HSA), atrial natrim'etic pepdde (ANP) and RAA hormones in the mid-luteal phase of the menstrual cycle. The ex-PE group was subdivided into two groups on the basis of a MAP above (BP-high) or below the median (BP-low). Variables of the two groups were compared with controls using the Mann-Whimey U test. RESULTS: Means • SD (p-values) of subjects' characteristics and significantly changing variables are listed in the table. Compared to controls, BP-high group showed a decreased ERPF and increased filtration fraction (FF) and renal vascular resistance (RVR). Both PV and ANP were lower in patients with a history of preeclampsia. It seems like BP-low group ~akes an intermediate position.
PI~, BP-low MAP ( m m H g ) 82 • 7 82 + 4 (0.62) BMI ( k g / m 2) 22 + 4 25 • 4 (0.06) Age (years) 33 • 2 28 -+ 4 (<0.01) ERPF ( m l / m i n / l . 7 3 m 2) 553 + 67 498 • 103 (0.10) GFR ( m [ / m i n / 1 . 7 3 m ~) 121 • 21 133 _+ 13 (0.22) FF (GFR/ERPF) 0.22 _+ 0.03 0.27 + 0.05 (0.0l) RVR • 10 -3 (dyn.s/cm ~) 7.49 + 0.87 8.55 -+ 1.72 (0.12) PV (ml/kg) 55 -+ 3 50 + 4 (0 02) ANP (pg/ml) 67 • 26 36 -+ 16 (<0.01)
PL, BP-high 100 24 30 464 130 0.2 11.01 52 45
• 13 (<0.01) • 3 (0.16) ~+ 3 (0.05) + 84 (0.03) • 21 (0.40) • 0.04 (<0.01) + 2.47 (<0.01) • 5 (0.07) • 22 (0.03)
CONCLUSIONS: Preeclampsia is tollowed by subclinical abnormalities in the volmne homeostasis and renal hemodynanfics, also in normotensives.
327
COAGULATION STUDY OF PREECIAtMPSIA AND TWIN GESTATION. H. Sasa~ K KomaLru~, X Mutotff, K. Taga ~, M. Kobayashi ~. Dept. Perinatal/ Maternal Med., National Defense Med. Coll., Tokorozawa, JAPAN. OBJECTIVE: To assess the hematological diffi~rences between preeclalnpsia and twin gestation by measuring markers o1 coagulation and fibrinolysis. STUDY DESIGN: Tissue factor (TF), TF pathway coagulation inhibition (TFPI), thrombonrodulin (TM), profllrombin fi-agment 1 + 2 (El+2), TAT, tPA, active PAI-1, tPA/PAI-I/C, PIC, fibrin + fibrinogen fi-agments (Fb+Fgfr), Fgfr and Fbfi- were measured by using ELISA method on the peripheral venous blood in 34 severely preeclamptic patients (singleton pregnancy), 28 twin gestations (non-preeclamptic) and 45 normal pregnancies (singleton control) in the third trinmster. RESULTS:
Preeclampsia Twin gestation Control
TF
7~PI
TM
F1 + 2 etc. *
PIC
Fg#/Fbfr
'{ ~ --~
]' ]' --+
T ~ --~
]' 1' ~
~' --~ ~
~" --~
*including TAT, tPA, active PAL1, tPA/PM-1/C, Fb+Fgfr, Fgfr and Fbfr CONCLUSIONS: Twin gestation was different from preeclampsia in slightly increased primmT fibrinolysis and the absence of endothelial dysfunction. Our data suggest that preeclampsia could be compatible with the state of chronic DIC and twin gestation, the state of pre DIC.
329
PLATELET AGGREGATION IN HYPERTENSIVE DISORDERS OF PREGNANCY. H. NisdF, C. GrunewakY, K. Karlbr ~, N. LunelP, C. Sylvdn x, M. Westgren. Dpts. O b / G y n & Medicine, Karolinska Institute, Huddinge, Sweden. OBJECTIVE: After addition of supraphysinlogical doses of substances stimulating platelet aggregation in vitro, a blunted response has been observed in preedampsia (PE). This has been interpreted as in vivo exhaustion of the platelets. The aim of the present study was to compare women with PE, pregnancy induced hypertension (P1H) and normotensive pregnant women (NP) with regard to different coagulation paramelers including filtragometD,, reflecting the in vivo situation more closely than conventional in vitro nlelbods. STUDY DESIGN: Blood was sampled for pIatelet count (PC) and analysis of antithrombin III (AT III) in 15 patients with PE (blood pressure (BP) > 1 4 0 / 9 0 nun H g and proteinuria >0.3 g after 20 weeks gestation), 11 with P1H (BP > 1 4 0 / 9 0 m m Hg, no proteinuria) and 13 NP in the third trimester. We also applied whole blood aggregometry in vitro by addition of 1 p,g collagen to 0.5 ml blood and fihragnmetty measuring spontaneous platelet aggregation (without addition of any aggregating substance) ex vivo by estimating the time to develop a pressure gradient of 10 m m over a filter occluded by platelet aggregates. Kruskall-Wallis lest was used for statistical analysis. RESULTS: PC were normal except in two patents with mild trombocytopenia in the PE group. AT III was lower in PE, (77, 59-102) (median, range) than in PIH, (89, 69-94) and NP (91, 70-116); p < 0.05. Aggregation after collagen was lower in PE (9.9, 4.2-16.9) than in PIH (19.3, 0.4-29.1) and NP (21.0, 2.5-28.3); p < 0.01. Aggregation time (seconds) during fihragometl T was similar in PE (65, 23-768) and PIH (87, 12-739) and shorter than in NP (494, 74-754), p < 0.05. CONCLUSIONS: PE but not PIH is associated with reduced platelet aggregation after in vitro addition of collagen, possibly rellecting exhaustion of platelets. The results from filtragometl T, more resembling tbe physiological situation, however, implies an enhanced platelet aggregation in PE but also also in PIH.
SPO Abstracts
J a n u a r y 1997 A m J O b s t e t Gynecol
ERYTHROUYrE AGGREGABILITY IN NORMAL PREGNANCY AND PREECLAMPSIA. D. Mankuta ~, A. P~ibustg, D. Meyerstein ~, M. Katz, N. Meyerstein ~. Dept. O b / G y n Soroka Med. Center, The Dr Kaufmann Hematology Lab Dept. Physiology, Chemistry Dept., Ben Gurioo University, Beer Sheva Israel. OBJECTIVE: The aim of this study was to examine the eiwtfirocyte aggregability and blood admittance of normal pregnant women and preeclamptic patients. STUDY DESIGN: The aggregability and admittance of 78 samples were quantified by a new method based upon the blood dielectric properties. In addition, the concentration of plasma proteins, Na + and K + levels and hematocrit (Hct) were assessed. The effect of low molecular weight dextran on the aggregability was exanfined. RESULTS: There were altered aggregability and blood admittance in both normal pregnancy and preeclamptie women compared with the control group. These changes rise with the duration of pregnancy and do not depend on variations in Hct and plasma composition (i.e., fibrinogen, albuinin sodium and potassimn levels). The aggregability and admittance of blood of normal pregnant women ditti~r from these parameters in preeclainpsia. The addition of low molecular weight dextran to blood samples partially reverts changes in the aggregability and blood admittance. The aggregability reaches nearly normal value when dextran concentration is lower than that used in clinical practice. CONCLUSIONS: E~3,throeyte aggregability and the blood admittance correlate with the duration of pregnancy. These indices for normal and preeelamptic women are different. The addition of low molecular weight dextran reverts aggregability up to nearly normal values. This finding suggests a way to correct in vitro aggregability in preeclampsia.
328
PREECLAMPSIA (PE) IS FOLLOWED BY SUBCLINICAL ABNORMALITIES IN VOLUME HOMEOSTASIS (VIt) AND RENAL HEMODYNAMICS (RH). E. van BeeU, 7". Ekha~?, P.W. de Leeuw% L.L.H. Peeters. Dept. Ob./Gyn. and Int. Med. #, Acadenaic Hospital Maasticht, Maastricht, The Netherlands. OBJECTIVE: Essential Hypertension (HT) is preceded by latent abnormalities in VH and RH (N Engl J Med 1991;324:1305-11). About 40% of ex-preeelamptics (ex-PE) are known to have HT. In this smdy we evaluated whether or not latent abnormalities in VH and RH are confined to H T subjects. STUDY DESIGN: ~'(e measured > 5 months postpartum after either a normal pregnancy (controls, n - 12) or a pregnancy complicated by PE (n - 25), the MAP (Dinamap), effective renal plasnla flow and glomerular filtration rate (ERPF and GFR, PAIl and inulin clearances), plasma volume (PV in m l / k g lean body mass, t2%HSA), atrial natrim'etic pepdde (ANP) and RAA hormones in the mid-luteal phase of the menstrual cycle. The ex-PE group was subdivided into two groups on the basis of a MAP above (BP-high) or below the median (BP-low). Variables of the two groups were compared with controls using the Mann-Whimey U test. RESULTS: Means • SD (p-values) of subjects' characteristics and significantly changing variables are listed in the table. Compared to controls, BP-high group showed a decreased ERPF and increased filtration fraction (FF) and renal vascular resistance (RVR). Both PV and ANP were lower in patients with a history of preeclampsia. It seems like BP-low group ~akes an intermediate position.
PI~, BP-low MAP ( m m H g ) 82 • 7 82 + 4 (0.62) BMI ( k g / m 2) 22 + 4 25 • 4 (0.06) Age (years) 33 • 2 28 -+ 4 (<0.01) ERPF ( m l / m i n / l . 7 3 m 2) 553 + 67 498 • 103 (0.10) GFR ( m [ / m i n / 1 . 7 3 m ~) 121 • 21 133 _+ 13 (0.22) FF (GFR/ERPF) 0.22 _+ 0.03 0.27 + 0.05 (0.0l) RVR • 10 -3 (dyn.s/cm ~) 7.49 + 0.87 8.55 -+ 1.72 (0.12) PV (ml/kg) 55 -+ 3 50 + 4 (0 02) ANP (pg/ml) 67 • 26 36 -+ 16 (<0.01)
PL, BP-high 100 24 30 464 130 0.2 11.01 52 45
• 13 (<0.01) • 3 (0.16) ~+ 3 (0.05) + 84 (0.03) • 21 (0.40) • 0.04 (<0.01) + 2.47 (<0.01) • 5 (0.07) • 22 (0.03)
CONCLUSIONS: Preeclampsia is tollowed by subclinical abnormalities in the volmne homeostasis and renal hemodynanfics, also in normotensives.
327
COAGULATION STUDY OF PREECIAtMPSIA AND TWIN GESTATION. H. Sasa~ K KomaLru~, X Mutotff, K. Taga ~, M. Kobayashi ~. Dept. Perinatal/ Maternal Med., National Defense Med. Coll., Tokorozawa, JAPAN. OBJECTIVE: To assess the hematological diffi~rences between preeclalnpsia and twin gestation by measuring markers o1 coagulation and fibrinolysis. STUDY DESIGN: Tissue factor (TF), TF pathway coagulation inhibition (TFPI), thrombonrodulin (TM), profllrombin fi-agment 1 + 2 (El+2), TAT, tPA, active PAI-1, tPA/PAI-I/C, PIC, fibrin + fibrinogen fi-agments (Fb+Fgfr), Fgfr and Fbfi- were measured by using ELISA method on the peripheral venous blood in 34 severely preeclamptic patients (singleton pregnancy), 28 twin gestations (non-preeclamptic) and 45 normal pregnancies (singleton control) in the third trinmster. RESULTS:
Preeclampsia Twin gestation Control
TF
7~PI
TM
F1 + 2 etc. *
PIC
Fg#/Fbfr
'{ ~ --~
]' ]' --+
T ~ --~
]' 1' ~
~' --~ ~
~" --~
*including TAT, tPA, active PAL1, tPA/PM-1/C, Fb+Fgfr, Fgfr and Fbfr CONCLUSIONS: Twin gestation was different from preeclampsia in slightly increased primmT fibrinolysis and the absence of endothelial dysfunction. Our data suggest that preeclampsia could be compatible with the state of chronic DIC and twin gestation, the state of pre DIC.
329
PLATELET AGGREGATION IN HYPERTENSIVE DISORDERS OF PREGNANCY. H. NisdF, C. GrunewakY, K. Karlbr ~, N. LunelP, C. Sylvdn x, M. Westgren. Dpts. O b / G y n & Medicine, Karolinska Institute, Huddinge, Sweden. OBJECTIVE: After addition of supraphysinlogical doses of substances stimulating platelet aggregation in vitro, a blunted response has been observed in preedampsia (PE). This has been interpreted as in vivo exhaustion of the platelets. The aim of the present study was to compare women with PE, pregnancy induced hypertension (P1H) and normotensive pregnant women (NP) with regard to different coagulation paramelers including filtragometD,, reflecting the in vivo situation more closely than conventional in vitro nlelbods. STUDY DESIGN: Blood was sampled for pIatelet count (PC) and analysis of antithrombin III (AT III) in 15 patients with PE (blood pressure (BP) > 1 4 0 / 9 0 nun H g and proteinuria >0.3 g after 20 weeks gestation), 11 with P1H (BP > 1 4 0 / 9 0 m m Hg, no proteinuria) and 13 NP in the third trimester. We also applied whole blood aggregometry in vitro by addition of 1 p,g collagen to 0.5 ml blood and fihragnmetty measuring spontaneous platelet aggregation (without addition of any aggregating substance) ex vivo by estimating the time to develop a pressure gradient of 10 m m over a filter occluded by platelet aggregates. Kruskall-Wallis lest was used for statistical analysis. RESULTS: PC were normal except in two patents with mild trombocytopenia in the PE group. AT III was lower in PE, (77, 59-102) (median, range) than in PIH, (89, 69-94) and NP (91, 70-116); p < 0.05. Aggregation after collagen was lower in PE (9.9, 4.2-16.9) than in PIH (19.3, 0.4-29.1) and NP (21.0, 2.5-28.3); p < 0.01. Aggregation time (seconds) during fihragometl T was similar in PE (65, 23-768) and PIH (87, 12-739) and shorter than in NP (494, 74-754), p < 0.05. CONCLUSIONS: PE but not PIH is associated with reduced platelet aggregation after in vitro addition of collagen, possibly rellecting exhaustion of platelets. The results from filtragometl T, more resembling tbe physiological situation, however, implies an enhanced platelet aggregation in PE but also also in PIH.