ANNALS OF IBADAN POSTGRADUATE MEDICINE
BURDEN OF CYTOPAENIAS AMONG HIV POSITIVE PREGNANT WOMEN AT THE UNIVERSITY COLLEGE HOSPITAL, IBADAN
O.A. Adesina1 , F. Fasola2 , O. Adekanbi3 , B. Ogunbosi4 , J. Akinyemi5 , M.A. Kuti6 , O. Michael5 , A. Fayemiwo7 , O. Awolude1 and I. Adewole1
Introduction: Few studies have examined cytopaenia among HIV positive pregnant women. Objectives: To assess burden of cytopaenia among HIV positive pregnant women.
Methodology: This cross-sectional study of women on HAART <6months, defined anemia as hematocrit <33%, leucopenia as total white blood cell count <3,000 cells/mm3 and thrombocytopenia as absolute platelet count <100,000 cells/mm3 . Univariate and bivariate analyses were performed.
Results: Over 8 years, of 1,197 women, the mean age was 29.02(±5.4) years and mean gestational age 25.9(±8.1) weeks. Prevalence of anaemia was 76.8%, leucopaenia 6.9% and thrombocytopenia 4.7%. The mean haematocrit was 28.5%(±4.5); median white blood count 5,500/mm3 ; median platelet count 200,000/mm3 and median CD4 323 cells/mm3 . Mean haematocrit was highest (29.7%±5.3) in women in the first trimester but lowest (28.4% ±4.6) in women in second trimester (p=0.04). Compared with earlier trimesters, women in the third trimester had higher median white blood count (5,600 cells/mm3), higher neutrophil (61.0% ±11.2) but lower lymphocytes (28.3%± 9.2) (p=0.18; 0.00, 0.00). Median absolute platelet count was highest (206,000 cells/mm3) in the first trimester but lowest (195,000 cells/mm3) in third trimester (0.04). Women with lower CD4 had higher prevalence of cytopaenias.
Conclusion: Cytopaenias are not uncommon in this population especially with lower CD4.
Dr. O.A. Adesina
Dept. of Obstetrics & Gynaecology,
College of Medicine,
University of Ibadan, Ibadan
The haematological profile of an individual is a simple, fast, cost-effective and reliable indicator of general health1,2. In the pregnant woman, the haematological profile has the potential to impact pregnancy and the outcome of that pregnancy3 . Pregnancy is also associated with various changes in hematological indices such as decrease in red blood cell count and platelet count1,4 and increase in white blood cell count5 . Similarly, haematological problems may be experienced by the pregnant woman. Anaemia is the most common haematological disorder in pregnancy and has the potential for adverse pregnancy outcomes such as low birth weight, miscarriages and low immunity6 . Anaemia in pregnancy results partly from a dilutional process secondary to a discrepancy between the rate of increase in plasma volume and that in red blood cell (RBC) mass1,4. While the plasma volume increases by 25% - 80% between the sixth and twenty-fourth weeks of gestation, the increase in RBC mass is approximately 30% and occurs between the twelfth and thirty-sixth weeks of gestation1 . Beside this physiological process, other possible causes of maternal anemia that the care provider must carefully evaluate for include nutritional deficiencies such as folate and iron deficiency, haemoglobinopathies7,8 and parasitic infections such as malaria especially in highly endemic regions like Nigeria8 .
Similarly, pregnancy is associated with a drop in platelet count, with many studies reporting approximately 10% drop in platelet count by the end of pregnancy9,10 . However, the majority of pregnant women still have platelet count within the normal range with most cases being mild, and no adverse outcome for mother or baby1 . In contrast to these reductions, various studies have reported that pregnancy is usually accompanied by leukocytosis mainly due to neutrophils11,12. Several changes have been reported in neutrophils during pregnancy. They include impairment of apoptosis due to increased inflammatory response, reduced chemotaxis and impaired respiratory burst 13,14. These changes have been associated with a boost in nonspecific (innate) immunity and are thought to be a compensation for the attenuation of specific immunity in pregnancy15. The impairment of specific immunity correlates with a reduction in lymphocyte count in pregnancy. Eosinophils and basophils also decline in number with increasing gestational age5, 16 .
The Human Immunodeficiency Virus (HIV) infection is not uncommon in pregnancy in sub-Saharan Africa16 . HIV is associated with hematological abnormalities, the most common manifestation being reduction in and impaired function of all blood cell lines; red blood cells (anemia), white blood cells (leucopenia or neutropenia) and platelets (thrombocytopenia) collectively called cytopenias.16 Cytopaenias increase in frequency as HIV progresses and are often fatal without intervention.17-19 Anemia is the most common cytopaenia and its presence has been associated with faster disease progression and an independent predictor of survival.17-21 The use of highly active antiretroviral therapy is associated with significant improvement in patient survival and improvement in anaemia especially severe anaemia18, 22, 23 .
Studies about the prevalence and factors associated with cytopaenia in patients living with HIV/AIDS has largely been done among the general adult HIV population17, 18, 21, 25-28. However, the magnitude of this problem has not been adequately described among HIV positive pregnant women.7, 29