University of Khartoum

Association of Thrombophilias with Pregnancy Complications in North Kordofan, El-Obied City, Sudan Year 2014.

Association of Thrombophilias with Pregnancy Complications in North Kordofan, El-Obied City, Sudan Year 2014.

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Title: Association of Thrombophilias with Pregnancy Complications in North Kordofan, El-Obied City, Sudan Year 2014.
Author: Elsafi, Siddig Safieldin Mohamed
Abstract: Background: Pregnancy complications are the leading causes of annual death for thousands women of reproductive age especially in developing countries. During pregnancy and puerperium, many changes affect the coagulation and fibrinolytic systems. Overall balance of haemostasis shifts towards hypercoagulability with growing evidence suggests that the pregnancy adverse complications are associated with inherited and acquired thrombophilias. So far, few similar studies have been conducted in Sudanese population. The aims of this study were to determine and compare the levels of haemostatic variables Activated protein C resistant (APCR), Lupus Anticoagulant (LA), Protein C (PC), Protein S (PS), Antithrombin III (ATIII), Homocysteine, blood coagulation factors (V, VIII, IX) and to examine the inherited thrombophilia Factor V Leiden (FVL), Prothrombin (PT), Mehtylenetetrahydrofolate reductase (MTHFR) in pregnant women with adverse pregnancy complications and healthy age-matched pregnant women. Methods: This is a hospital-based case-control study that included 134 women with one or more pregnancy complications e.g. preeclampsia, placental abruption, intrauterine growth restriction, stillbirth, venous thromboembolism and 125 healthy control group conducted at El-Obied Teaching Hospital, north Kordofan, Sudan over a period of three years (July 2014 to July 2017). Three blood samples (citrated, EDTA, clotted,) each 2.0 ml were collected from the study population. Citrated plasma for coagulation studies was obtained by mixing nine parts of whole blood with one part of 3.2 % tri-sodium citrate. Special assay protocol for an auto-analyzer from Dade Behring Company, Marburg, Germany, BCs was followed. Serum for homocysteine assay was separated and stored immediately at – 20C. Homocysteine assay was done using an Immunoassay analyzer, AXSYM System, from ABBOTT Company. EDTA sample was used for molecular analyses which have been done by strip assay protocol from Vienna Lab. Statistical analysis was performed using the SPSS version 17 unpaired t-test. Results: The (APCR) was increased (Test ratio = 0.88, normal ratio more than 2) in 13 patients with still birth compared to 4 controls (p=0.05) and in venous thromboembolism was increased in 4 patients and one control, the ratio was 0.86 (p=0.06). Acquired hyperhomocysteinaemia was significantly increased in 13 patients with preeclampsia (mean value = 10.2 mmol) and 5 controls (mean value = 7.4 mmol) p=0.01. Lupus Anticoagulant was detected in patients compared to controls as low positive ( 1.2 – 1.5 ratio) with Preeclampsia (5 to 1), Placental abruption (1 to 1), IUGR (3 to 1), Stillbirth (2 to 1 ) and VTE one high positive (> 2 ratio) to one low positive control. Protein C was increased in stillbirth with a mean value of 113% compared to 95% in control (p= 0.004). Protein S was reduced in study population (mean = 42%), normal range (60 -140%). The blood coagulation factors V, VIII and IX were increased relatively in patients. The mean concentrations % in patients compared to controls FV (132 / 114), FVIII (129 / 111) and FIX (115/ 107). Heterozygous mutation was detected in low frequency in patients and controls. FVL=1.8%, PT= 3.7% in patients compared to 0.00 % and 4% controls respectively. Conclusion: The acquired activated protein C resistant (APCR) and acquired hyperhomocysteinaemia were detected significantly in patients compared to control group. Blood coagulation factors V, VIII, IX were elevated relatively in patients than controls. The level of PS was significantly reduced in all patients as well as the control group without complications. The homozygous forms of inherited thrombophilia FVL, PT, were absent in this study. Only one homozygous MTHFR was detected in one patient with preeclampsia who lost her baby later. She had the highest homocysteine level in this study. Further studies with larger number for each criteria, acquired and inherited thrombophilia testing, treatment and prophylaxis definitely will improve the pregnancy outcomes.
URI: http://khartoumspace.uofk.edu/123456789/27166


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