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Abstract(s)
Introdução: durante a gravidez ocorrem alterações hematológicas necessárias para cumprir
as novas necessidades da mãe e do feto, de entre as quais a diminuição da contagem plaquetar.
Apesar de a sua causa permanecer, ainda, desconhecida, parece refletir a hemodiluição, a diminuição
da produção de plaquetas e o aumento do seu turnover. Deve, porém, ser referido que, apesar de
fisiológica, em alguns casos, esta queda pode culminar em valores trombocitopénicos ou patológicos.
A trombocitopenia materna (contagem de plaquetas inferior a 150x109/L), ocorre em cerca de 10%
das gestações, sendo a segunda complicação mais frequente do foro hematológico na grávida. Além
do mais, tendo por base estado de stress inflamatório controlado, que é a gravidez, alguns parâmetros
inflamatórios têm sido correlacionados com o desenvolvimento de diversas patologias obstétricas.
Objetivos: investigar possíveis fatores de risco para o desenvolvimento de trombocitopenia
durante a gravidez, bem como consequências do mesmo, e o papel dos índices inflamatórios como
marcadores prognósticos.
Métodos: estudo observacional transversal retrospetivo, concretizado com recurso aos
processos clínicos de mães e recém-nascidos, e respetivas análises clínicas, cujo parto ocorreu no
CHUCB, Covilhã, entre Janeiro e Dezembro de 2018. A análise estatística foi realizada através dos
programas informáticos Microsoft Excel 365® e IBM SPSS 25.0®.
Resultados: no presente estudo verificamos que a prevalência global de trombocitopenia
materna no 3º trimestre no CHUCB entre Janeiro e Dezembro de 2018 foi de 14,4%. De entre esses
91,3% trataram-se de casos leves, 7,2% de grau moderado e 1,4% de grau severo. A média de idade
das grávidas foi 31,6 ± 5,3 anos de idade. Na análise da evolução das plaquetas verificou-se valores
significativamente mais baixos, desde o 1º trimestre, para o grupo com trombocitopenia. Foram
avaliados os ratios inflamatórios neutrófilos/linfócitos (NLR), plaquetas/linfócitos (PLR) e índice
inflamatório sistémico (SII). Foi possível evidenciar relação entre os valores diminuídos do PLR e do
SII e o desenvolver de trombocitopenia de 3º trimestre. Verificou-se, ainda, correlação com
significância entre a trombocitopenia de 3º trimestre e a maior probabilidade de necessidade de
reanimação do recém-nascido (RN) no momento do parto.
Conclusão: Apesar de não ser um tema muito estudado na realidade portuguesa, a elevada
prevalência da trombocitopenia materna e determinadas causas e desfechos a ela associados fazem
desta alteração gestacional um tema pertinente a estudar. Durante a gravidez dá-se uma regulação
fisiológica do sistema imunitário inato para prevenir a rejeição do feto, que se reflete num estado de
stress inflamatório controlado. Os valores diminuídos dos marcadores inflamatórios nas grávidas com
trombocitopenia, obtidos neste estudo, fazem ponderar sob um possível papel da imunidade no
desenvolvimento de trombocitopenia. A possível aplicabilidade como marcadores prognósticos no
futuro, comprovada com este estudo, relativamente aos marcadores inflamatórios, ressalta a
necessidade de mais investigação nesta área, ainda tão pouco explorada.
Introduction: during pregnancy, there are hematological changes necessary to fulfill the new needs of the mother and fetus, among which the decrease in platelet count. Although its cause remains unknown, it seems to reflect hemodilution, platelet decreased production and increased turnover. Nonetheless, it should be mentioned that, despite being physiological, in some cases, this fall may culminate in thrombocytopenic or pathological values. Maternal thrombocytopenia (platelet count lower than 150x109/L) occurs in about 10% of pregnancies, with the second most frequent complication of hematological forum in pregnant women. Moreover, based on the state of controlled inflammatory stress, which is pregnancy, some inflammatory parameters have been correlated with the development of several obstetric pathologies. Objectives: to investigate possible risk factors for the development of thrombocytopenia during pregnancy, as well as this development consequences, and the role of inflammatory indices as prognostic markers. Methods: a retrospective cross-sectional observational study carried out using mothers and newborns’ clinical processes and clinical analyses, whose delivery occurred in CHUCB, Covilhã, between January and December 2018. Statistical analysis was performed using Microsoft Excel 365® and IBM SPSS 25.0® software. In the data analysis, descriptive and analytic statistics were used. Results: In the present study, we found out that the overall prevalence of maternal thrombocytopenia in the 3rd trimester in the CHUCB between January and December of 2018 was 14.4%. Among the cases with 3-trimester thrombocytopenia, 91.3% of cases were mild, 7.2% were moderate and 1.4% had severe degrees. The average age of the pregnant women was 31.6 ± 5.3 years of age. The analysis of platelet evolution showed significantly lower values for the group with thrombocytopenia, since the first trimester. The inflammatory ratios neutrophils/lymphocytes (NLR), platelets/lymphocytes (PLR) and Systemic Inflammatory index (SII) were evaluated. It has been possible to demonstrate a relationship between the decreased values of PLR and SII and the development of third trimester thrombocytopenia. Additionally, there was also a significant correlation between the third trimester thrombocytopenia and the higher probability of the newborn (NB) need to resuscitation at the time of delivery. Conclusion: despite not being a very studied topic in Portugal, the high prevalence of maternal thrombocytopenia and certain associated causes and outcomes make this gestational change.
Introduction: during pregnancy, there are hematological changes necessary to fulfill the new needs of the mother and fetus, among which the decrease in platelet count. Although its cause remains unknown, it seems to reflect hemodilution, platelet decreased production and increased turnover. Nonetheless, it should be mentioned that, despite being physiological, in some cases, this fall may culminate in thrombocytopenic or pathological values. Maternal thrombocytopenia (platelet count lower than 150x109/L) occurs in about 10% of pregnancies, with the second most frequent complication of hematological forum in pregnant women. Moreover, based on the state of controlled inflammatory stress, which is pregnancy, some inflammatory parameters have been correlated with the development of several obstetric pathologies. Objectives: to investigate possible risk factors for the development of thrombocytopenia during pregnancy, as well as this development consequences, and the role of inflammatory indices as prognostic markers. Methods: a retrospective cross-sectional observational study carried out using mothers and newborns’ clinical processes and clinical analyses, whose delivery occurred in CHUCB, Covilhã, between January and December 2018. Statistical analysis was performed using Microsoft Excel 365® and IBM SPSS 25.0® software. In the data analysis, descriptive and analytic statistics were used. Results: In the present study, we found out that the overall prevalence of maternal thrombocytopenia in the 3rd trimester in the CHUCB between January and December of 2018 was 14.4%. Among the cases with 3-trimester thrombocytopenia, 91.3% of cases were mild, 7.2% were moderate and 1.4% had severe degrees. The average age of the pregnant women was 31.6 ± 5.3 years of age. The analysis of platelet evolution showed significantly lower values for the group with thrombocytopenia, since the first trimester. The inflammatory ratios neutrophils/lymphocytes (NLR), platelets/lymphocytes (PLR) and Systemic Inflammatory index (SII) were evaluated. It has been possible to demonstrate a relationship between the decreased values of PLR and SII and the development of third trimester thrombocytopenia. Additionally, there was also a significant correlation between the third trimester thrombocytopenia and the higher probability of the newborn (NB) need to resuscitation at the time of delivery. Conclusion: despite not being a very studied topic in Portugal, the high prevalence of maternal thrombocytopenia and certain associated causes and outcomes make this gestational change.
Description
Keywords
Fatores de Risco Marcadores Inflamatórios Obstetrícia Trombocitopenia Materna