European Journal of Obstetrics & Gynecology and Reproductive Biology
White blood cell count as a predictor of the severity of sickle cell disease during pregnancy
Introduction
Most women with sickle cell disease (SCD) now survive to reproduce, with an average life expectancy of approximately 50 years in the developed world [1]. Sickle cell crises occur more frequently during pregnancy [2]. The morbidity and mortality of the condition is high in pregnancy [3] and affected women are more at risk of stillbirth, pre-eclampsia, preterm delivery and poor fetal growth [4], [5]. There are considerable differences in the type and severity of clinical manifestations among pregnant women and their babies.
Research on SCD has recently focused on the role of leukocytes [6], [7], [8]. Increasing epidemiological evidence implicates leukocytosis at steady-state (i.e. when not in crisis and with no detectable infection) as a major risk factor for poor outcome in non-pregnant SCD patients. SCD has been associated with high steady-state leukocyte count [9]. High steady-state neutrophil count has been correlated with clinical severity of SCD [10]. The previous studies excluded pregnant patients. Since high steady-state leukocyte counts predispose to greater severity of SCD in non-pregnant patients, we hypothesized that the same could be true during pregnancy.
The aim of this study was to investigate whether the early steady-state WBC count is associated with the clinical severity of SCD later in pregnancy.
Section snippets
Materials and methods
The study was carried out retrospectively at the maternity unit of Guy's and St Thomas’ NHS Foundation Trust, a London teaching hospital with 5800 deliveries per year and a multi-ethnic population with high risk for SCD. Women with SCD are enrolled into antenatal care as early as possible, are closely monitored by a multidisciplinary team consisting of obstetricians, haematologists and specialist midwives, with access to consultant obstetric physician. There is low threshold for admission in
Results
Forty-one women fulfilled the inclusion criteria; one was excluded for developing obstetric cholostasis (n = 40). The mean age was 29.9 years (range 19–40). Twenty-three patients had HbSS genotype and 17 had HbSC. The mean gestational age at the time of entry into antenatal care was 14.3 weeks (median 13, range 6–20). All pregnancies were singleton and all women were on oral folic acid 5 mg once daily. Eighteen women were on long-term prophylactic oral penicillin V 250 mg once daily and remained on
Comment
The classical view of SCD has always focused on the primary genetic defect: the abnormal sickle haemoglobin that polymerises when deoxygenated. Polymerisation within the red cell causes it to deform, become rigid, obstruct the blood flow, and produce acute and chronic tissue damage because of poor perfusion [7]. More recent studies see the sickle red cell in a wider context, as it interacts with the vascular endothelium and its surrounding cells [12] with mediation by different adhesion
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Adverse maternal and perinatal outcomes in pregnant women with sickle cell disease: Systematic review and meta-analysis
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Leukocytosis is a risk factor for lung function deterioration in children with sickle cell disease
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