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A longitudinal, cross-sectional study of diversity in maternal platelet count kinetics, related to gestational thrombocytopenia

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Title: A longitudinal, cross-sectional study of diversity in maternal platelet count kinetics, related to gestational thrombocytopenia
Authors: Kotera, Kohei / Kamihira, Shimeru / Kerckhove, Charles de / Kanematsu, Takashi / Matsuda, Kazuyuki / Miura, Kiyonori / Hasegawa, Hiroo / Masuzaki, Hideaki
Issue Date: Jan-2018
Publisher: Nagasaki University School of Medicine / 長崎大学医学部
Citation: Acta medica Nagasakiensia, 61(3), pp.117-126; 2018
Abstract: Background: Gestational thrombocytopenia (GT) is detected in approximately 8% of healthy pregnant women and >70% of pregnancy-associated thrombocytopenia cases. Diagnosed by exclusion, GT is primarily a benign disorder of unclear pathogenesis, although mechanisms have been proposed such as hemodilution. To better understand GT, we conducted retrospective longitudinal and cross-sectional analyses of variations in platelet count (PC) during gestation period. Methods: PC kinetics was assessed across a test group of 100 pregnant women, accurately representative of 341 in total, and in a control group of 200 non-pregnant women. Results: In the test group, median PC was comparable to the control group in early gestation but decreased by 8% by delivery day (DD). PC decreased by >5% in 59 pregnancies and increased by >5% in 19. 12 cases were thrombocytopenic. Median PC fluctuation, 2.5th percentile, and 97.5th percentile were each most extreme in final 5 weeks. Longitudinal analysis established five gestational pattern types defined by curvature and Change Ratio. The GT-type pattern (8 cases) showed relatively low PC in early gestation, mild downwards slope in the 2nd trimester, one or more peaks or “lifts” in the final weeks, followed by a “V-shape” of decrease beyond 15 x 104/μL to DD and sharp post-partum increase. Some of the GT-associated characteristics above appeared identifiable in a majority of pregnancies regardless of absolute PC value: Distinct PC “lift” occurring within the final ten weeks [later than in GT cases] followed by the V-shape [decrease to DD less pronounced than in GT], suggesting that diverse PC kinetics relate to the placental cytokine and receptor system. Conclusion: Our novel identification of diverse kinetic patterns in platelet count over gestational period suggests that, instead of a universal decrease caused by hemodilution alone, homeostatic conditions are affected by a diversity of varying factors such as the placental thrombopoietic system.
Keywords: platelet count / intra-individual variation / gestation / thrombocytopenia
URI: http://hdl.handle.net/10069/37960
ISSN: 00016055
Type: Departmental Bulletin Paper
Text Version: publisher
Appears in Collections:Volume 61, No. 3

Citable URI : http://hdl.handle.net/10069/37960

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