Ektopik gebelik ve düşük tehdidi tanısında hemogram parametrelerinin değerlendirilmesi
Year 2021,
Volume: 46 Issue: 1, 63 - 69, 31.03.2021
Jule Eriç Horasanlı
,
Hüseyin Görkemli
,
Eren Berkay Özkaya
Mehmet Murat Işıkalan
,
Delal Akıncı
,
Fatma Kılıç
Abstract
Amaç: Bu çalışmanın amacı ektopik gebelik ve düşük tehdidi mevcut olan hastaların hemogram parametrelerini, normal intrauterin gebeliği olan hastalar ile karşılaştırmak, bu parametrelerin ektopik gebelik erken tanısında ve düşük tehdidi ayrımında kullanılabilirliğini araştırmaktır.
Gereç ve Yöntem: Çalışmamız Ocak 2016-Ocak 2019 tarihleri arasında hastanemizde ektopik gebelik tanısı ile medikal ya da cerrahi yolla tedavi edilmiş (n:50), ve düşük tehdidi tanısı ile hospitalize edilmiş hastalar (n:50) ile normal intrauterin gebeliği mevcut olan hastalar (n:50) arasında retrospektif bir araştırma olarak planlandı. Tüm hastaların preoperatif ve hastaneye yatış hemogram kan parametreleri dosyalarından elde edildi. Tüm gruplarda sosyodemografik veriler, tam kan sayımı kaydedildi. Nötrofil lenfosit oranı (NLR), trombosit lenfosit oranı (PLR), lenfosit monosit oranı (LMR) hesaplandı.
Bulgular: Düşük tehdidi ve ektopik gebeliklerde lenfosit sayısı, kontrol grubuna göre daha yüksek olarak saptandı. PDW, ektopik gebeliklerde kontrol grubuna göre anlamlı düzeyde düşük saptandı. Monosit değerleri, düşük tehdidi grubunda kontrol grubuna göre anlamlı olarak daha yüksek bulundu. Düşük tehdidinde PLR kontrol grubuna göre anlamlı olarak daha düşük saptandı.
Sonuç: PDW değerlerinin düşük bulunması ektopik gebelikte mikroçevreyi değiştirerek gebeliğin implantasyonu bozmakla suçlanmaktadır. Mevcut çalışmada PDW değerlerinin ektopik gebelikte düşük bulunması nedeni ile bu parametre kullanılarak, erken tanısında faydalı olabilir.
References
- Kaynaklar
1. Stulberg DB, Cain LR, Dahlquist I, Lauderdale DS. Ectopic pregnancy rates in the Medicaid population. Am J Obstet Gynecol. 2013;208(4):274.e1-.e7.
- 2. Farquhar CM. Ectopic pregnancy. Lancet. 2005;366(9485):583-91.
- 3. Varma R, Gupta J. Tubal ectopic pregnancy. BMJ Clin Evid. 2009;2009.
- 4. Arbab F, Goldsby J, Matijevic-Aleksic N, Huang G, Ruan K-H, Huang J-C. Prostacyclin is an autocrine regulator in the contraction of oviductal smooth muscle. Hum Reprod. 2002;17(12):3053-9.
- 5. Paradisi R, Maldini-Casadei M, Boni P, Busacchi P, Porcu E, Venturoli S. T-helper 2-cytokine levels in women with threatened abortion. Eur J Obstet Gynecol Reprod Biol. 2003;111(1):43-9.
- 6. King A. Uterine leukocytes and decidualization. Hum Reprod Update. 2000;6(1):28-36.
- 7. Dosiou C, Giudice LC. Natural killer cells in pregnancy and recurrent pregnancy loss: endocrine and immunologic perspectives. Endocr Rev. 2005;26(1):44-62.
- 8. Proctor MJ, Morrison DS, Talwar D, Balmer SM, Fletcher CD, O'Reilly DS, et al. A comparison of inflammation-based prognostic scores in patients with cancer. A Glasgow Inflammation Outcome Study. Eur J Cancer. 2011;47(17):2633-41.
- 9. de Jager CP, van Wijk PT, Mathoera RB, de Jongh-Leuvenink J, van der Poll T, Wever PC. Lymphocytopenia and neutrophil-lymphocyte count ratio predict bacteremia better than conventional infection markers in an emergency care unit. Crit Care. 2010;14(5):R192.
- 10. Ishizuka M, Shimizu T, Kubota K. Neutrophil-to-lymphocyte ratio has a close association with gangrenous appendicitis in patients undergoing appendectomy. Int Surg. 2012;97(4):299-304.
- 11. Wagner DD, Burger PC. Platelets in inflammation and thrombosis. Arterioscler Thromb Vasc Biol. 2003;23(12):2131-7.
- 12. Shaw JL, Dey SK, Critchley HO, Horne AW. Current knowledge of the aetiology of human tubal ectopic pregnancy. Hum Reprod Update. 2010;16(4):432-44.
- 13. Ata N, Kulhan M, Kulhan NG, Turkler C. Can neutrophil-lymphocyte and platelet-lymphocyte ratios predict threatened abortion and early pregnancy loss? Ginekol Pol. 2020;91(4):210-5.
- 14. Feng Q-T, Chen C, Yu Q-Y, Chen S-Y, Huang X, Zhong Y-L, et al. The benefits of higher LMR for early threatened abortion: A retrospective cohort study. PLoS One. 2020;15(4):e0231642.
- 15. Eskicioğlu F, Özdemir AT, Turan GA, Gür EB, Kasap E, Genç M. The efficacy of complete blood count parameters in the diagnosis of tubal ectopic pregnancy. Ginekol Pol. 2014;85(11):823-7.
- 16. Bouyer J, Coste J, Shojaei T, Pouly JL, Fernandez H, Gerbaud L, et al. Risk factors for ectopic pregnancy: a comprehensive analysis based on a large case-control, population-based study in France. Am J Epidemiol. 2003;157(3):185-94.
- 17. Barnhart KT. Ectopic Pregnancy. N Engl J Med. 2009;361(4):379-87.
- 18. Daponte A, Pournaras S, Zintzaras E, Kallitsaris A, Lialios G, Maniatis AN, et al. The value of a single combined measurement of VEGF, glycodelin, progesterone, PAPP-A, HPL and LIF for differentiating between ectopic and abnormal intrauterine pregnancy. Hum Reprod. 2005;20(11):3163-6.
- 19. Cartwright J, Duncan WC, Critchley HO, Horne AW. Serum biomarkers of tubal ectopic pregnancy: current candidates and future possibilities. Reproduction. 2009;138(1):9-22.
- 20. Artunc Ulkumen B, Pala HG, Calik E, Oruc Koltan S. Can Mean Platelet Volume and Platelet Distrubition Width be Possible Markers for Ectopic Pregnancy and Tubal Rupture? (MPV and PDW in Ectopic Pregnancy). Pak J Med Sci. 2014;30(2):352-5.
- 21. Cabar FR, Fettback PB, Pereira PP, Zugaib M. Serum markers in the diagnosis of tubal pregnancy. Clinics (Sao Paulo). 2008;63(5):701-8.
- 22. Turgut A, Sak ME, Ozier A, Soydinc HE, Karacor T, Gul T. Alteration of peripheral blood cells in tubal ectopic pregnancy. Ginekol Pol. 2013;84(3).
- 23. Dundar O, Yoruk P, Tutuncu L, Akyol Erikci A, Muhcu M, Ergur AR, et al. Longitudinal study of platelet size changes in gestation and predictive power of elevated MPV in development of pre‐eclampsia. Prenatal Diagnosis: Published in Affiliation With the International Society for Prenatal Diagnosis. 2008;28(11):1052-6.
- 24. Ihara A, Kawamoto T, Matsumoto K, Shouno S, Morimoto T, Noma Y. Relationship between Hemostatic Factors and the Platelet Index in Patients with Ischemic Heart Disease. Pathophysiol Haemost Thromb. 2006;35(5):388-91.
- 25. Lee HJ, Park TC, Kim JH, Norwitz E, Lee B. The Influence of Oral Dydrogesterone and Vaginal Progesterone on Threatened Abortion: A Systematic Review and Meta-Analysis. Biomed Res Int. 2017;2017:3616875.
- 26. Kim YM, Bujold E, Chaiworapongsa T, Gomez R, Yoon BH, Thaler HT, et al. Failure of physiologic transformation of the spiral arteries in patients with preterm labor and intact membranes. Am J Obstet Gynecol. 2003;189(4):1063-9.
- 27. Ferguson KK, Meeker JD, McElrath TF, Mukherjee B, Cantonwine DE. Repeated measures of inflammation and oxidative stress biomarkers in preeclamptic and normotensive pregnancies. Am J Obstet Gynecol. 2017;216(5):527.e1-.e9.
- 28. Imtiaz F, Shafique K, Mirza SS, Ayoob Z, Vart P, Rao S. Neutrophil lymphocyte ratio as a measure of systemic inflammation in prevalent chronic diseases in Asian population. Int Arch Med. 2012;5(1):2.
- 29. Gencdal S, Aydogmus H, Gencdal NK, Destegul E, Ekmekci E. Evaluation of the Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio in Patients With Ectopic Pregnancies2019.
- 30. Yilmaz M, Delibas IB, Isaoglu U, Ingec M, Borekci B, Ulug P. Relationship between mean platelet volume and recurrent miscarriage: a preliminary study. Archives of medical science : AMS. 2015;11(5):989-93.
- 31. Bas FY, Tola EN, Sak S, Cankaya BA. The role of complete blood inflammation markers in the prediction of spontaneous abortion. Pak J Med Sci. 2018;34(6):1381-5.
Evaluation of hemogram parameters in the diagnosis of ectopic pregnancy and threatened abortion
Year 2021,
Volume: 46 Issue: 1, 63 - 69, 31.03.2021
Jule Eriç Horasanlı
,
Hüseyin Görkemli
,
Eren Berkay Özkaya
Mehmet Murat Işıkalan
,
Delal Akıncı
,
Fatma Kılıç
Abstract
Purpose: The aim of this study is to compare hemogram parameters of patients with the threat of ectopic pregnancy and abortion with those of patients with normal intrauterine pregnancy, and to investigate the utility of these parameters in the diagnosis of ectopic pregnancy and distinction of threatened abortion.
Materials and Methods: This study was planned as a retrospective study including patients diagnosed with ectopic pregrancy who were treated medically or surgically (n: 50), patients diagnosed with normal intrauterine pregnancy (n: 50), and patients hospitalized with the diagnosis of threatened abortion (n:50). Preoperative and during hospitalization hemogram blood parameters of all patients were obtained from their files. Sociodemographic data, complete blood count data were recorded and neutrophyl lymphocyte ratio (NLR) platelet lymphocyte ratio (PLR) and lymphocyte monocyte ratio (LMR) were calculated.
Results: In threatened abortion and ectopic pregnancies, lymphocyte count was found much higher than that of control group. PDW was significantly lower in ectopic pregnancies compared to control group. Monocyte values were significantly higher in threatened abortion group compared to control group. PLR was significantly lower in threatened abortion group compared to control group.
Conclusion: Low PDW values are accused of disrupting pregnancy implantation by changing microenvironment in ectopic pregnancy. Since PDW values were found low in ectopic pregnancy group in our study, it may be useful to use this parameter in early diagnosis.
References
- Kaynaklar
1. Stulberg DB, Cain LR, Dahlquist I, Lauderdale DS. Ectopic pregnancy rates in the Medicaid population. Am J Obstet Gynecol. 2013;208(4):274.e1-.e7.
- 2. Farquhar CM. Ectopic pregnancy. Lancet. 2005;366(9485):583-91.
- 3. Varma R, Gupta J. Tubal ectopic pregnancy. BMJ Clin Evid. 2009;2009.
- 4. Arbab F, Goldsby J, Matijevic-Aleksic N, Huang G, Ruan K-H, Huang J-C. Prostacyclin is an autocrine regulator in the contraction of oviductal smooth muscle. Hum Reprod. 2002;17(12):3053-9.
- 5. Paradisi R, Maldini-Casadei M, Boni P, Busacchi P, Porcu E, Venturoli S. T-helper 2-cytokine levels in women with threatened abortion. Eur J Obstet Gynecol Reprod Biol. 2003;111(1):43-9.
- 6. King A. Uterine leukocytes and decidualization. Hum Reprod Update. 2000;6(1):28-36.
- 7. Dosiou C, Giudice LC. Natural killer cells in pregnancy and recurrent pregnancy loss: endocrine and immunologic perspectives. Endocr Rev. 2005;26(1):44-62.
- 8. Proctor MJ, Morrison DS, Talwar D, Balmer SM, Fletcher CD, O'Reilly DS, et al. A comparison of inflammation-based prognostic scores in patients with cancer. A Glasgow Inflammation Outcome Study. Eur J Cancer. 2011;47(17):2633-41.
- 9. de Jager CP, van Wijk PT, Mathoera RB, de Jongh-Leuvenink J, van der Poll T, Wever PC. Lymphocytopenia and neutrophil-lymphocyte count ratio predict bacteremia better than conventional infection markers in an emergency care unit. Crit Care. 2010;14(5):R192.
- 10. Ishizuka M, Shimizu T, Kubota K. Neutrophil-to-lymphocyte ratio has a close association with gangrenous appendicitis in patients undergoing appendectomy. Int Surg. 2012;97(4):299-304.
- 11. Wagner DD, Burger PC. Platelets in inflammation and thrombosis. Arterioscler Thromb Vasc Biol. 2003;23(12):2131-7.
- 12. Shaw JL, Dey SK, Critchley HO, Horne AW. Current knowledge of the aetiology of human tubal ectopic pregnancy. Hum Reprod Update. 2010;16(4):432-44.
- 13. Ata N, Kulhan M, Kulhan NG, Turkler C. Can neutrophil-lymphocyte and platelet-lymphocyte ratios predict threatened abortion and early pregnancy loss? Ginekol Pol. 2020;91(4):210-5.
- 14. Feng Q-T, Chen C, Yu Q-Y, Chen S-Y, Huang X, Zhong Y-L, et al. The benefits of higher LMR for early threatened abortion: A retrospective cohort study. PLoS One. 2020;15(4):e0231642.
- 15. Eskicioğlu F, Özdemir AT, Turan GA, Gür EB, Kasap E, Genç M. The efficacy of complete blood count parameters in the diagnosis of tubal ectopic pregnancy. Ginekol Pol. 2014;85(11):823-7.
- 16. Bouyer J, Coste J, Shojaei T, Pouly JL, Fernandez H, Gerbaud L, et al. Risk factors for ectopic pregnancy: a comprehensive analysis based on a large case-control, population-based study in France. Am J Epidemiol. 2003;157(3):185-94.
- 17. Barnhart KT. Ectopic Pregnancy. N Engl J Med. 2009;361(4):379-87.
- 18. Daponte A, Pournaras S, Zintzaras E, Kallitsaris A, Lialios G, Maniatis AN, et al. The value of a single combined measurement of VEGF, glycodelin, progesterone, PAPP-A, HPL and LIF for differentiating between ectopic and abnormal intrauterine pregnancy. Hum Reprod. 2005;20(11):3163-6.
- 19. Cartwright J, Duncan WC, Critchley HO, Horne AW. Serum biomarkers of tubal ectopic pregnancy: current candidates and future possibilities. Reproduction. 2009;138(1):9-22.
- 20. Artunc Ulkumen B, Pala HG, Calik E, Oruc Koltan S. Can Mean Platelet Volume and Platelet Distrubition Width be Possible Markers for Ectopic Pregnancy and Tubal Rupture? (MPV and PDW in Ectopic Pregnancy). Pak J Med Sci. 2014;30(2):352-5.
- 21. Cabar FR, Fettback PB, Pereira PP, Zugaib M. Serum markers in the diagnosis of tubal pregnancy. Clinics (Sao Paulo). 2008;63(5):701-8.
- 22. Turgut A, Sak ME, Ozier A, Soydinc HE, Karacor T, Gul T. Alteration of peripheral blood cells in tubal ectopic pregnancy. Ginekol Pol. 2013;84(3).
- 23. Dundar O, Yoruk P, Tutuncu L, Akyol Erikci A, Muhcu M, Ergur AR, et al. Longitudinal study of platelet size changes in gestation and predictive power of elevated MPV in development of pre‐eclampsia. Prenatal Diagnosis: Published in Affiliation With the International Society for Prenatal Diagnosis. 2008;28(11):1052-6.
- 24. Ihara A, Kawamoto T, Matsumoto K, Shouno S, Morimoto T, Noma Y. Relationship between Hemostatic Factors and the Platelet Index in Patients with Ischemic Heart Disease. Pathophysiol Haemost Thromb. 2006;35(5):388-91.
- 25. Lee HJ, Park TC, Kim JH, Norwitz E, Lee B. The Influence of Oral Dydrogesterone and Vaginal Progesterone on Threatened Abortion: A Systematic Review and Meta-Analysis. Biomed Res Int. 2017;2017:3616875.
- 26. Kim YM, Bujold E, Chaiworapongsa T, Gomez R, Yoon BH, Thaler HT, et al. Failure of physiologic transformation of the spiral arteries in patients with preterm labor and intact membranes. Am J Obstet Gynecol. 2003;189(4):1063-9.
- 27. Ferguson KK, Meeker JD, McElrath TF, Mukherjee B, Cantonwine DE. Repeated measures of inflammation and oxidative stress biomarkers in preeclamptic and normotensive pregnancies. Am J Obstet Gynecol. 2017;216(5):527.e1-.e9.
- 28. Imtiaz F, Shafique K, Mirza SS, Ayoob Z, Vart P, Rao S. Neutrophil lymphocyte ratio as a measure of systemic inflammation in prevalent chronic diseases in Asian population. Int Arch Med. 2012;5(1):2.
- 29. Gencdal S, Aydogmus H, Gencdal NK, Destegul E, Ekmekci E. Evaluation of the Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio in Patients With Ectopic Pregnancies2019.
- 30. Yilmaz M, Delibas IB, Isaoglu U, Ingec M, Borekci B, Ulug P. Relationship between mean platelet volume and recurrent miscarriage: a preliminary study. Archives of medical science : AMS. 2015;11(5):989-93.
- 31. Bas FY, Tola EN, Sak S, Cankaya BA. The role of complete blood inflammation markers in the prediction of spontaneous abortion. Pak J Med Sci. 2018;34(6):1381-5.