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العنوان
Platelets Distribution Width as a Severity Marker for Preeclampisa /
المؤلف
Abd-Allah, Mahmoud Nabil.
هيئة الاعداد
باحث / Mahmoud Nabil Abd-Allah
مشرف / Hazem Amin Hassan AlZenini
مشرف / Amr Ahmed Mahmoud Riad
مناقش / Amr Ahmed Mahmoud Riad
تاريخ النشر
2018.
عدد الصفحات
159p. :
اللغة
الإنجليزية
الدرجة
ماجستير
التخصص
أمراض النساء والتوليد
تاريخ الإجازة
1/1/2018
مكان الإجازة
جامعة عين شمس - كلية الطب - النساء والتوليد
الفهرس
Only 14 pages are availabe for public view

from 159

from 159

Abstract

Pre-eclampsia is described as the “disease of theories” because although research has been conducted for many years it still remains poorly understood and unpredictable, thus management and classification of the condition is still under debate.
The disease process, initiated within the placenta and the vascular endothelium, starts early in pregnancy, many weeks before manifestation of clinical disease.
The common theory that pre-eclampsia is primarily a placental function disorder is further reinforced by cases with molar and anembryonic pregnancies which develop pre-eclampsia that resolves only after the pregnancy has been terminated
Platelets are miniscule, anucleated blood cells that consist of cytoplasmic organelles, a cytoskeleton and granules. They generally have a flat surface and are irregular in shape, which allows for haemostasis. The shape of platelets is dynamic and changes depending on the level of activation, where the activated platelet has an irregular branch-like shape and the resting platelet has a smoother surface. The size also differs depending on the maturity of the cell, where the more immature the platelet, the larger the size.
Platelet count, in the context of pre-eclampsia and its complications, is used to determine the severity of disease, and helps the clinician decide when to expedite delivery. It is also used to determine the mode of anesthesia as well as whether a platelet transfusion is required.
Measuring the platelet count using full blood count technology is only one example of how platelet function is assessed, acting as a screening tool and raising red flags if an abnormal count is reported. However, the count itself cannot establish the cause of thrombocytopaenia, and further functional tests need to be conducted.
The most common theory for thrombocytopaenia in pre-eclampsia is that of increased platelet activation. The actual trigger remains unclear, but is thought to be abnormal eicasanoid production related to placental dysfunction.
Studies have aimed to prove this theory by demonstrating an increase in markers that rise during platelet activation. Some of the markers include raised levels of the compound urinary 11-dehydrothromboxane b2/mg creatinine, B-thromboglobulin, platelet factor 4, CD63, CD62P, fibrinogen antigens and increased platelet volume.
Due to alterations in coagulation, the PDW has an important role in the progression of PE: therefore, not only the platelet count but also the platelet function should be carefully assessed.
Considering the role of the PDW and platelet indices during the disease as well as the alteration of coagulation, this study aimed to evaluate the feasibility of using platelet indices as a severity marker for PE.
A comparison was held between MPV, PDW in mildly preeclamptic (mPE), severely preeclamptic (sPE), and healthy normotensive pregnant females, to evaluate whether these parameters were of predictive and/or prognostic significance in determining (respectively) the risk and severity of PE.
Mean platelet volume (MPV) varied significantly between the three groups; being higher in the severe preeclampsia group compared to the other two groups and also higher in the mild preeclampsia group compared to the control group.
Also, significant differences were found between the three groups in platelet distribution width. It was larger in the severe preeclampsia group compared to the other two groups and also in the mild preeclampsia group compared to the control group.
Overall, statistically significant correlation was found between MPV and PDW and severity of preeclmpsia. A statistically significant correlation was found between both indices and systolic and diastolic blood pressure measurements, liver transaminases, serum creatinine and albuminuria Also, a statistically significant negative correlation was found between both indices and platelet count.
A limitation of this study was the lack of serial detection of the PDW through the complete pregnancy period. The time that the PDW increases during pregnancy will need further evaluation. Also, further research will be needed to assess the power of platelet count and platelet indices in predicting the progression of severe preeclampsia or its probable use in the timing of delivery for women with preeclampsia