Avaliação de parâmetros plaquetários e marcadores relacionados à angiogênese nas síndromes hipertensivas gestacionais

Abstract

Preeclampsia (PE) and other pregnancy hypertensive disorders (PHD) are responsible for a substantial fraction of maternal and neonatal deaths. The physiopathology of PE is complex and concerns endothelial dysfunction and platelet activation, which is considered a key element in the development of PE. Platelet indices have been studied in numerous diseases. These are provided by new generation hematology analyzers mostly without any additional cost. There is evidence of the association between platelet indices and the incidence of PHD, which could be helpful tools for the diagnosis and management of these patients. Thus, this study aimed to assess the behavior of platelet indices in the PHD. 32 healthy non-pregnant and 268 pregnant women were included in this study. 114 were in the control group (C), 112 were diagnosed with pregnancy hypertension (PH), and 42 with preeclampsia (PE). The parameters of impedance and fluorescence platelet counts (PLT-I and PLT-F, respectively), plateletcrit (PCT), mean platelet volume (MPV), platelet distribution width (PDW), platelet large cell ratio (P-LCR) and immature platelet fraction (IPF% and IPF#, percentage and absolute count respectively) were obtained with the hematology analyzer Sysmex XN-1000. The levels of the angiogenesis-related biomarkers sFlt-1 and PlGF were measured by electrochemiluminescence immunoassays in the Cobas e 411 analyzer. In the comparison between groups PLT-I, PLT-F, PCT were lower for HG and PE than C, whereas VPM, PDW, P-LCR, IPF%, and IPF# were higher for PE and HG. These results indicate increased platelet activation and turnover. The sFlt-1 was increased in HG and PE, while the sFlt-1/PlGF was higher for PE in comparison with HG and C. These finds are characteristic of placental dysfunction in PE. There was a moderate positive correlation between sFlt-1 and the platelet indices VPM, PDW e P-LCR. Platelet indices provide useful information about the platelet activation and turnover in patients with suspect or diagnosis of PHD. These parameters can be used as additional tools for the management of patients with PHD.