妊娠晚期血小板参数及凝血指标异常结果分析

Analysis on the abnormal results of platelet parameters and coagulation indexes during the third trimester of pregnancy

目的:总结分析妊娠晚期导致孕妇血小板及凝血检测结果异常的原因、发生频率以及检测方法上要注意的问题。方法:以2008年9月～2009年8月间的住院孕妇作为研究对象,按妊娠并发症分类,以正常晚期妊娠妇女作为对照,分析血小板参数、凝血常规四项(PT、APTT、TT、FIB)。结果:①妊娠高血压综合征(PIH)组和妊娠糖尿病(GDM)组的血小板平均体积(MPV)值高于对照组;②妊高征组血小板降低、MPV升高、凝血指标未见明显异常。③妊娠糖尿病组的PT、APTT、FIB与对照组比较有显著性差异。④妊娠晚期孕妇发生血小板减少的原因以妊娠生理性原因和重度妊高征为主(58.4%和20.7%),其他原因还包括:双胎妊娠、母儿血型不合、EDTA依赖性假性PLT减少。结论:多种妊娠相关性疾病可引起妊娠晚期孕妇的血小板减少,血小板参数异常,同时需要注意鉴别EDTA依赖性假性PLT减少,避免误诊。

Objective： To summarize and analyze the causes and frequencies of abnormal results of platelet detection and coagula- tion test, and the problems needing attention for detection methods among the pregnant women during the third trimester of pregnancy. Methods ： The pregnant women who hospitalized in the hospital from September 2008 to August 2009 were selected as study objects, then they were classified according to pregnant complications ; the normal pregnant women during the third trimester of pregnancy were selected as control group, the platelet parameters and four coagulation indexes, including prothrombin time （PT） , activated partial thrombo- plastin time （AP＇IT）, thrombin time （TF） and fibrinogen, were analyzed. Results： The mean platelet volumes （MPV） in hypertensive disorder complicating pregnancy （HDCP） group and gestational diabetes mellitus （GDM） group were significantly higher than that in control group. In HDCP group, the count of platelet decreased, MPV increased, there was no apparent abnormality in coagulation indexes. There was significant difference in PT, APTT, and fibrinogen between GDM group and control group. The main causes of thromboeytopenia among the pregnant women during the third trimester of pregnancy were physiological reason （58.4%） and severe HDCP （20. 7% ） , other causes included twin pregnancy, maternal - fetal blood group incompatibility, and EDTA - dependent pseudothrombocytopenia. Conclusion： A variety of pregnancy - associated diseases can cause thrombocytopenia and abnormal platelet parameters among the pregnant women during the third trimester of pregnancy, meanwhile, EDTA - dependent pseudothrombocytopenia should be differentiated carefully to avoid misdiagnosis.