Haemostatic reference intervals in pregnancy

Abstract

Haemostatic reference intervals are generally based on samples from non-pregnant women. Thus, they may not be relevant to pregnant women, a problem that may hinder accurate diagnosis and treatment of haemostatic disorders during pregnancy. In this study, we establish gestational age-specific reference intervals for coagulation tests during normal pregnancy. Eight hundred one women with expected normal pregnancies were included in the study. Of these women, 391 had no complications during pregnancy, vaginal delivery, or postpartum period. Plasma samples were obtained at gestational weeks 13-20, 21-28, 29-34, 35-42, at active labor, and on postpartum days 1 and 2. Reference intervals for each gestational period using only the uncomplicated pregnancies were calculated in all 391 women for activated partial thromboplastin time (aPTT), fibrinogen, fibrin D-dimer, antithrombin, free protein S, and protein C and in a subgroup of 186 women in addition for prothrombin time (PT), Owren and Quick PT, protein S activity, and total protein S and coagulation factors II, V, VII, VIII, IX, X, XI, and XII. The level of coagulation factors II, V, X, XI, XII and antithrombin, protein C, aPTT, PT remained largely unchanged during pregnancy, delivery, and postpartum and were within non-pregnant reference intervals. However, levels of fibrinogen, D-dimer, and coagulation factors VII, VIII, and IX increased markedly. Protein S activity decreased substantially, while free protein S decreased slightly and total protein S was stable. Gestational age-specific reference values are essential for the accurate interpretation of a subset of haemostatic tests during pregnancy, delivery, and puerperium.

Persistent organic pollutants and haematological markers in Greenlandic pregnant women: the ACCEPT sub-study

“…Due to physiological changes and general maternal health, the haematological markers change during pregnancy [22,35]. Moreover, the haematological markers are an important diagnostic tool, e.g.…”

Dynamics of hevostatic parameters on pregnant women and after delivery

“…В работе использовали следующую панель со-временного оборудования, применяющуюся в оте чес твенных клинико-диагностических лабора-ториях*: гематологический анализатор MEK-7222 J/K [1] («Nihon Kohden»); агрегометры оптические -Chronolog 490-4D [2] («CHRONO-LOG Corporation») и AggRAM [3] («Helena Laboratories»); коагулометры полуавтоматические -Helena C-1 [4] , АПГ4-02П [5] («ЭМКО») и Start 4 [6] («Stago»); автоматические ко-агулометры -STA Compact [7] («Stago») и Sysmex CA-1500 [8] («Sysmex Corporation»); планшетный флюориметр Fluoroskan Ascent [9] («ThermoFisher SCIENTIFIC») с программным обеспечением Thrombinoscope 3.0.0.26; тромбоэластометр 4-ка-нальный ROTEM Gamma [10] («Rotem»); иммуно-химические анализаторы -IMMULITE 2000 [11] («Siemens Healthcare Diagnostics») и Architect i2000 [12] ОРИГИНАЛЬНЫЕ И ОБЗОРНЫЕ СТАТЬИ («ABBOTT LABORATORIES S.A.»); фотометры -спектрофотометр Photometr 5010 v5+ [13] («Robert Riele GmbH &Co KG»), микропланшетный фото-метр Bio-Rad 680 [14] («Bio-Rad Laboratories»); экс-пресс-анализатор (рефлектометр) [15] NycoCard Rider II («Axis Shield»); регистратор Тромбодинамика Т-2 [16] («ГемаКор», Россия).…”

“…Она заключается в том, что лаборатор-ные показатели системы гемостаза на практике у беременных женщин, как правило, соотносят с допустимыми интервалами значений коагулограм-мы, определенных для небеременных женщин, что не позволяет принимать обоснованные клиниче-ские решения [12]. Различия в технологиях про-ведения диагностических исследований создают дополнительные трудности в интерпретации полу-чаемых результатов.…”

A Review of Hemostasis in Normal Pregnancy and Puerperium

“…Normal pregnancy is accompanied by a progressive rise in clotting factors II, V, VII, VIII, IX, X, XII, fibrinogen [3,19,20,43,44], von Willebrand factor (vWF) [21] and tissue factor [45]. However stable and non-rising trends in II, X, XI were also reported [46]. The rise in clotting factors is considered to be a consequence of hormonal changes particularly estrogen [23].…”

“…This was considered as an effect of consumption similar to the pathogenesis of maternal thrombocytopenia. Overall, there is no effect on prothrombin time (PT) and activated partial thromboplastin time (APTT) [46].…”