J Clin Gynecol Obstet
Journal of Clinical Gynecology and Obstetrics, ISSN 1927-1271 print, 1927-128X online, Open Access
Article copyright, the authors; Journal compilation copyright, J Clin Gynecol Obstet and Elmer Press Inc
Journal website http://www.jcgo.org

Original Article

Volume 2, Number 1, June 2013, pages 27-30


Platelet Indices and Blood Groups in Early Recurrent Miscarriage: A Study in Pregnant Women

Nermin Akdemira, Arif Serhan Cevrioglua, Selcuk Ozdena, Betul Kurua, Filiz Bilira, Cemil Bilirb, c

aDepartment of Gynecology and Obstetrics, Sakarya University School of Medicine, Turkey
bDepartment of Internal Medicine, Bulent Ecevit University School of Medicine, Turkey
cCorresponding author: Cemil Bilir, Sultan orhan mh 1145 sk no:14 Gebze, Turkey.

Manuscript accepted for publication March 14, 2013
Short title: Platelet Indices in Miscarriage
doi: https://doi.org/10.4021/jcgo90e

Abstract▴Top 

Background: Recurrent miscarriage estimated prevalence with 1% to 3% of pregnancies and the probable causes of recurrent miscarriage are multiple, ranging from genetic, environmental, infectious, metabolic, and endocrine to anatomic causes. However, there is no study in the literature to date about the platelet indices in recurrent miscarriage.

Methods: This observational, retrospective study was investigated a total of 51 recurrent miscarriage patient and 64 healthy controls.

Results: MPV values were none significantly higher in controls than ERM (8.2 vs 8.1, P 0.75). Also there were no significantly differences between the groups related to WBC, PDW, platecrit, platelet and glucose levels. There was no significant correlation between the number of miscarriage and MPV, PDW and platectrit (P 0.25, 0.3 and 0.7, respectively).

Conclusions: In conclusion, this is the first study which compares the platelet indices in the recurrent pregnancy loss. Platelet indices such as MPV, PDW and platecrit didn’t risk factor for recurrent miscarriage in pregnant women. There is no significant difference for ABO blood group in recurrent miscarriage and control.

Keywords: Miscarriage; MPV; PDW; Blood group

Introduction▴Top 

Recurrent miscarriage is defined as two consecutive miscarriages without a previous birth or three miscarriages, whether or not interspersed with a term delivery of a healthy child. Pregnancy loss is very common and precise prevalence of early recurrent miscarriage (ERM) is dependent on its definition, but it has estimated prevalence with 1% to 3% of pregnancies [1]. Furthermore, etiology of ERM has most causes. Boue et al and Hassold et al accepted that at least 50% of clinical abortions result from chromosomal abnormalities [2, 3]. Age and success of previous pregnancies are two independent risk factors that affect the miscarriage [4]. The probable causes of recurrent miscarriage are multiple, ranging from genetic, environmental, infectious, metabolic and endocrine to anatomic causes. The best defined causes are parental chromosomal abnormalities, metabolic abnormalities, and anatomic abnormalities [1]. Blood group incompatibility can affect reproduction. Couples with incompatibility blood groups’ experiences spontaneous miscarriage or stillbirth more frequently [5, 6]. However, there is not enough study about the ABO blood group in ERM patients and also no study published to date platelet parameters such as MPW, PDW and platecrit levels in recurrent miscarriage.

Method▴Top 

Study population

This observational, retrospective study was conducted in the Sakarya University School of Medicine, Department of Gynecology and Obstetrics clinic. A total of 51 recurrent miscarriage patient and 64 healthy controls between March 2010 and November 2011 were enrolled. The Institutional Review Board of the Sakarya University Faculty of Medicine approved the study. The local ethics committee has also approved the study. Inclusion criteria’s were; (1) two consecutive miscarriages without a previous birth or three miscarriages whether or not interspersed with a term delivery of a healthy child, (2) pregnant women with gestational age before 13 weeks. Exclusion criteria were as follows (1) having a chronic disease such as diabetes, uncontrolled hypertension, hypothyroidism, hyperthyroidism, renal failure or heart disease, (2) abnormal pelvic ultrasound and known anatomic defects, uterine abnormality, (3) luteal phase deficiency, (4) having thrombophilias and or antiphospholipid syndrome, (5) smoking, previous thrombosis/embolism history.

For all participants, clinical risk factors and other demographic data were recorded from hospital records. Complete blood count samples which were drawn into vacutainer tubes containing 0.04 mL of the 7.5% K salt of EDTA were analyzed within 30 minutes after sampling with a commercially available analyzer.

Statistical analyses

All statistical analyses were conducted by using the SPSS 17.0 statistical software program (SPSS, Chicago, IL). Continuous variables were presented as mean ± standard deviation and categorical variables as percentages. Data with normal distribution were analyzed using unpaired t test. Mann-Whitney U test was used for analyzing non-normally distributed data. Categorical variables were compared with the chi-square test. A cut off value of MPV was calculated with roc curve analysis. Correlations were studied using Pearson’s correlation test. P values under the 0.05 were considered as statistically significant.

Results▴Top 

Clinical and laboratory findings of the patients with ERM and controls were presented in Table 1. There were no statistically significant differences between the groups with regard to age and laboratory parameters. MPV values were none significantly higher in controls than ERM (8.2 vs 8.1, P 0.75). Furthermore, there were no significantly differences between the groups related to WBC, PDW, platecrit, thrombocyte and glucose levels. ABO blood groups for ERM and controls were presented in the Table 2. The most common blood group was A (50%) in the ERM group and there was no significant difference to the control group. There were no significantly differences between the groups for ABO blood groups (chi square P 0.98). Also there was no significantly a difference between the groups for rh group (P 0.7). ERM group had 22 patients with two abortions, 19 patients had 3; four patients had 4; six patients had 5 or more abortions. There was no significant correlation between the number of miscarriage and MPV, PDW and platectrit (P 0.25, 0.3 and 0.7, respectively).

Table 1.
Click to view
Table 1. Comparison of the General Characteristics of Patients With ERM and Controls
 

Table 2.
Click to view
Table 2. ABO Blood Groups in ERM and Control Group
 
Discussion▴Top 

In this study, we found that ABO blood groups and platelet parameters such as MPV, PDW, Platecrits, did not an etiopathologic risk factor for early recurrent miscarriage in our population.

The causes of recurrent miscarriage are multiple and best defined causes are parental chromosomal abnormalities, metabolic abnormalities, and anatomic abnormalities [1] but there are lots of unknown causes. Platelet dysfunction can be one of these causes. Mean platelet volume (MPV) is a machine-calculated measurement of platelet size from the blood that is usually reported in the blood tests as part of the CBC. Furthermore, it has been shown that MPV is the most accurate measure of the size of platelets in stable conditions and inversely associated with platelet count. In comparison to smaller platelets, larger platelets contain more granules and produce greater amounts of prothrombotic factors, such as thromboxane A2 and serotonin, also they aggregate rapidly under a stimulus and express a greater number of adhesion molecules, such as P-selectin and glycoprotein IIb/IIIa [7-12]. In obstetric population, increased MPV have been described as precursors to the onset of preeclampsia, diabetes mellitus and intrauterine growth restriction [13, 14]. To date, there is no study about MPV values in ERM. Kosus et al didn’t find any significant differences between the MPV and missed abortion [15]. Furthermore, we did not find too in our study population.

Platelet distribution width (PDW) is novel platelet indices and accepted as a platelet activation marker [16]. Platelet activation causes morphologic changes of platelets by pseudopodoia formation. Increased PDW have been shown in the vaso-occlusive in sickle cell disease, ischemic heart disease [17, 18]. Also PDW had not been studied in pregnant population before. Platelet activation should be a risk factor for ERM, but we didn’t find significant differences between the ERM group and control (17.8 vs 18, P 0.7).

ABO Bloods group incompatibility is a risk factor in recurrent abortion. Ghasemi et al found that type 1 ABO blood incompatibility, defined as when wife and husband have two different blood groups, is a risk factor for pregnancy loss [19]. In addition, were coupled with incompatibility blood groups’ experiences spontaneous miscarriage or stillbirth more frequently [6, 20]. In our study, we could not compare the blood groups in couples but according to control group any of the ABO blood groups didn’t take a risk to recurrent miscarriage in our pregnant population.

There are some study limitations such as this study designed as a retrospective study, also we have limited number of study population and we couldn’t compare the parents and fetus ABO blood group.

In conclusion, this is the first study which compares the platelet indices in the recurrent pregnancy loss. Platelet indices such as MPV, PDW and platecrit didn’t risk factor for ERM in pregnant women. There was no significant difference for ABO blood group in ERM and control.

Declaration

All of authors did not conflict of interest and we did not receive any funding for this study.


References▴Top 
  1. Dhont M. Recurrent miscarriage. Curr Womens Health Rep. 2003;3(5):361-366.
    pubmed
  2. Boue J, Bou A, Lazar P. Retrospective and prospective epidemiological studies of 1500 karyotyped spontaneous human abortions. Teratology. 1975;12(1):11-26.
    doi pubmed
  3. Hassold T, Chen N, Funkhouser J, Jooss T, Manuel B, Matsuura J, Matsuyama A, et al. A cytogenetic study of 1000 spontaneous abortions. Ann Hum Genet. 1980;44(Pt 2):151-178.
    doi pubmed
  4. Abdalla HI, Burton G, Kirkland A, Johnson MR, Leonard T, Brooks AA, Studd JW. Age, pregnancy and miscarriage: uterine versus ovarian factors. Hum Reprod. 1993;8(9):1512-1517.
    pubmed
  5. Satyanarayana M, Vijayalakshmi M, Rao CS, Mathew S. ABO blood groups and fertility—with special reference to intrauterine selection due to materno-fetal incompatibility. Am J Phys Anthropol. 1978;49(4):489-496.
    doi pubmed
  6. Chakravartti MR, Chakravartti R. ABO blood groups and fertility in an Indian population. J Genet Hum. 1978;26(2):133-144.
    pubmed
  7. Levin J, Bessman JD. The inverse relation between platelet volume and platelet number. Abnormalities in hematologic disease and evidence that platelet size does not correlate with platelet age. J Lab Clin Med. 1983;101(2):295-307.
    pubmed
  8. Thompson CB, Jakubowski JA. The pathophysiology and clinical relevance of platelet heterogeneity. Blood. 1988;72(1):1-8.
    pubmed
  9. Karpatkin S. Heterogeneity of human platelets. I. Metabolic and kinetic evidence suggestive of young and old platelets. J Clin Invest. 1969;48(6):1073-1082.
    doi pubmed
  10. Martin JF, Trowbridge EA, Salmon G, Plumb J. The biological significance of platelet volume: its relationship to bleeding time, platelet thromboxane B2 production and megakaryocyte nuclear DNA concentration. Thromb Res. 1983;32(5):443-460.
    doi
  11. Bath PM, Butterworth RJ. Platelet size: measurement, physiology and vascular disease. Blood Coagul Fibrinolysis. 1996;7(2):157-161.
    doi
  12. Thompson CB, Jakubowski JA, Quinn PG, Deykin D, Valeri CR. Platelet size as a determinant of platelet function. J Lab Clin Med. 1983;101(2):205-213.
    pubmed
  13. Dundar O, Yoruk P, Tutuncu L, Erikci AA, Muhcu M, Ergur AR, Atay V, et al. Longitudinal study of platelet size changes in gestation and predictive power of elevated MPV in development of pre-eclampsia. Prenat Diagn. 2008;28(11):1052-1056.
    doi pubmed
  14. Bozkurt N, Yilmaz E, Biri A, Taner Z, Himmetoglu O. The mean platelet volume in gestational diabetes. J Thromb Thrombolysis. 2006;22(1):51-54.
    doi pubmed
  15. Kosus N, Kosus A, Yildirim M, Duran M, Turhan NO. Mean platelet volume as a marker of thrombosis in patients with missed abortion. Acta Haematol. 2011;125(4):208-209.
    doi pubmed
  16. Vagdatli E, Gounari E, Lazaridou E, Katsibourlia E, Tsikopoulou F, Labrianou I. Platelet distribution width: a simple, practical and specific marker of activation of coagulation. Hippokratia. 2010;14(1):28-32.
    pubmed
  17. Amin MA, Amin AP, Kulkarni HR. Platelet distribution width (PDW) is increased in vaso-occlusive crisis in sickle cell disease. Ann Hematol. 2004;83(6):331-335.
    doi pubmed
  18. Khandekar MM, Khurana AS, Deshmukh SD, Kakrani AL, Katdare AD, Inamdar AK. Platelet volume indices in patients with coronary artery disease and acute myocardial infarction: an Indian scenario. J Clin Pathol. 2006;59(2):146-149.
    doi pubmed
  19. Ghasemi N, Sheikhha MH, Davar R, Soleimanian S. ABO Bloods group incompatibility in recurrent abortion. Iranian Journal of Pediatric Hematology Oncology22011;1:1.
  20. Gualtieri CT, Hicks RE, Mayo JP. ABO incompatibility and parity effects on perinatal mortality. Soc Biol. 1985;32(1-2):129-131.
    pubmed


This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Journal of Clinical Gynecology and Obstetrics is published by Elmer Press Inc.

 

Browse  Journals  

     

Journal of Clinical Medicine Research

Journal of Endocrinology and Metabolism

Journal of Clinical Gynecology and Obstetrics

World Journal of Oncology

Gastroenterology Research

Journal of Hematology

Journal of Medical Cases

Journal of Current Surgery

Clinical Infection and Immunity

Cardiology Research

World Journal of Nephrology and Urology

Cellular and Molecular Medicine Research

Journal of Neurology Research

International Journal of Clinical Pediatrics

 

 

 

 

 

Journal of Clinical Gynecology and Obstetrics, quarterly, ISSN 1927-1271 (print), 1927-128X (online), published by Elmer Press Inc.                     
The content of this site is intended for health care professionals.
This is an open-access journal, the authors retain the copyright, the journal is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International
License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Creative Commons Attribution license (Attribution-NonCommercial 4.0 International CC-BY-NC 4.0)


This journal follows the International Committee of Medical Journal Editors (ICMJE) recommendations for manuscripts submitted to biomedical journals,
the Committee on Publication Ethics (COPE) guidelines, and the Principles of Transparency and Best Practice in Scholarly Publishing.

website: www.jcgo.org   editorial contact: editor@jcgo.org
Address: 9225 Leslie Street, Suite 201, Richmond Hill, Ontario, L4B 3H6, Canada

© Elmer Press Inc. All Rights Reserved.