Rinder H M, Bonan J L, Anandan S, Rinder C S, Rodrigues P A, Smith B R
Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT 06510.
Am J Obstet Gynecol. 1994 Jan;170(1 Pt 1):117-22. doi: 10.1016/s0002-9378(94)70395-7.
Our purpose was to determine platelet kinetics in pregnancy by means of noninvasive reticulated platelet counts and to examine in a pilot study whether increased reticulated platelet values were associated with preeclampsia and pregnancy-induced hypertension.
Nulliparous women had blood samples drawn at enrollment (first prenatal visit) and at 28 and 36 weeks' gestation. The percent of reticulated platelets (an index of marrow platelet release correlating with increased thrombopoiesis), platelet-associated immunoglobulin, and serum antiplatelet antibody were measured and correlated with the clinical course for each patient.
In 31 normal pregnancies the percent of reticulated platelets was never significantly higher than the values for normal nonpregnant women (5.8% +/- 2.2%) in spite of a significant decrease in platelet count by 36 weeks. By contrast, the percent of reticulated platelets in four women with preeclampsia rose significantly to 13.9% +/- 11.2% at 28 weeks, before the onset of clinical signs. No women had evidence of immune platelet destruction.
In normal pregnancy the decline in platelet count is not accompanied by an increase in marrow platelet production, suggesting that the platelet decrease is dilutional without a compensatory thrombopoietic response or alternatively that thrombopoiesis is down-regulated during normal pregnancy. However, platelet production does increase before the onset of symptoms in a small number of women in whom preeclampsia or pregnancy-induced hypertension subsequently develops. These findings may justify a larger prospective study to determine whether noninvasive serial measurement of the percent of reticulated platelets can predict those pregnant women at risk for hypertension and preeclampsia.
我们的目的是通过无创性网织血小板计数来确定妊娠期血小板动力学，并在一项初步研究中检验网织血小板值升高是否与先兆子痫和妊娠高血压相关。
未生育女性在入组时（首次产前检查）以及妊娠28周和36周时采集血样。测量网织血小板百分比（与血小板生成增加相关的骨髓血小板释放指标）、血小板相关免疫球蛋白和血清抗血小板抗体，并将其与每位患者的临床病程进行关联。
在31例正常妊娠中，尽管到36周时血小板计数显著下降，但网织血小板百分比从未显著高于正常非妊娠女性的值（5.8%±2.2%）。相比之下，4例先兆子痫女性的网织血小板百分比在临床症状出现前的28周时显著升至13.9%±11.2%。没有女性有免疫性血小板破坏的证据。
在正常妊娠中，血小板计数下降并不伴随着骨髓血小板生成增加，这表明血小板减少是稀释性的，没有代偿性血小板生成反应，或者在正常妊娠期间血小板生成被下调。然而，在少数随后发生先兆子痫或妊娠高血压的女性中，血小板生成在症状出现前确实增加。这些发现可能为一项更大规模的前瞻性研究提供依据，以确定网织血小板百分比的无创性连续测量是否能够预测那些有高血压和先兆子痫风险的孕妇。
