Development of a Novel Early Diagnostic Criteria for Dilutional Anemia using Maternal Total Plasma Protein Levels and Hemoglobin Concentrations in Pregnant Women Attending Antenatal Clinic at University of Calabar Teaching Hospital, Calabar
Forwah Jacques Ndeh *
Department of Hematology and Blood Transfusion Sciences, Faculty of Clinical Sciences, University of Calabar, Cross River State, Nigeria.
Otti Chidiebere Joel
Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital Ituku-Ozalla, Enugu State, Nigeria.
Edeani Bobby David
Department of Radiation Oncology, University of Nigeria Teaching Hospital Ituku -Ozalla, Enugu State, Nigeria.
Korzerzer Samuel Vershima
Department of Surgery, University of Nigeria Teaching Hospital Ituku -Ozalla, Enugu State, Nigeria.
Ebot Walter Ojong
Department of Biomedical Science, Faculty of Health Sciences, University of Buea, South West Region, Cameroon.
Okorie Ebubechukwu Obasi
Department of Radiation Medicine, University of Nigeria Teaching Hospital Ituku-Ozalla, Enugu State, Nigeria.
Edim Okimedim Joseph
Department of Hematology and Immunology University of Nigeria Teaching Hospital Ituku -Ozalla, Enugu State, Nigeria.
Emekwue Chukwudi Alex
Department of Internal Medicine, Enugu State University Teaching Hspital, Enugu State, Nigeria.
Immaculate Ihuoma Ekeagba
Department of Integrated Health Sciences and Technological Training, Faculty of Multi-Medical Education and Innovative Research, WORCACCCE Union Group University Institute, P.O. Box 45 Bamenda, North West Region, Cameroon.
Ekwueme Chinaza Ndubuisi
Department of Internal Medicine, Enugu State University Teaching Hospital, Enugu State, Nigeria.
Odinichi Okolo Eboh
Department of Obstetrics and Gynecology, University of Benin Teaching Hospital, Edo State, Nigeria.
Okwu Prudence Chidera
Department of Internal Medicine, Enugu State University Teaching Hospital, Enugu State, Nigeria.
Akaba Kingsley Onoride
Department of Hematology and Blood Transfusion Sciences, Faculty of Clinical Sciences, University of Calabar, Cross River State, Nigeria.
Abeshi Sylvester Etenikang
Department of Obstetrics and Gynecology, University of Calabar Teaching Hospital, Cross Rivers State, Nigeria.
*Author to whom correspondence should be addressed.
Abstract
Background: Dilutional anaemia has been hypothesized to be a common complication in pregnancy usually characterized by decreased hemoglobin concentration due to increased blood volume and changes in maternal total plasma protein levels. However, accurate measurement of combined hemoglobin and total plasma protein levels are yet to be recognized by researchers as early new diagnostic criteria parameters for its management and differentiation from other types of gestational anemias
Objective: The index study was aimed at establishing a new early criterion for the diagnosis of dilutional anemia using maternal total plasma protein levels and maternal hemoglobin concentration estimated using five different types of hemoglobinometers during the trimesters of pregnancy among pregnant women attending the Antenatal clinic at University of Calabar Teaching Hospital (UCTH) Calabar compare to non-pregnant women.
Methods: This cross-sectional study involved 400 participants comprising of (n=200 registered pregnant women (50%) and n=200 non-pregnant women (50%) with ages from 18 years and above, who had been previously counseled and had completed an opened-ended, semi-structured self-administered questionnaire form after providing informed / written consent. All blood samples collected by standard methods, were analyzed for total plasma protein levels using Biuret’s spectrophotometric method, while hemoglobin concentration was measured using HemoCue rapid diagnostic test, micro-hematocrit /Packed cell volume (PCV), Copper sulphate (CuSO4) gravimetric method, Tallquist’s hemoglobin scale and Sahli’s method (also called as acid hematin method which is the visual comparator method for the estimation of hemoglobin).
Results: The Mean age ± SD (years) for pregnant women was 24.99±1.01 compared to non-pregnant women 29.95±7.85 with statistically significant difference between ages (P<0.05, t=7.2822, P=0.0001).The mean value plus one standard deviation (X±SD) of total plasma protein (TPP) levels in g/dl for first, second, third trimesters and total for pregnant women at which dilution anemia occurred were 6.47 ± 0.88, 5.7± 0.76, 5.6 ± 0.67 and 5.92 ± 0.77 respectively compared to 7.48±.79 for non-pregnant women. The mean value plus one standard deviation of hemoglobin concentration in g/dl per trimester using the five different type of hemoglobinometers at which dilutional anemia occurred were 12.77±.52,11.4 ± 0.23,10.9± 0.89 and 10.98± 0.36 respectively for pregnant women compared to 12.84±1.7 for nonpregnant women. The prevalence of dilutional anemia was significantly higher in pregnant women (03.5%) compared to non-pregnant women (1.5%).
Conclusion: This study highlights the importance of accurate hemoglobin concentration measurement throughout the three trimesters of pregnancy using reliable five different types of point of care testing rapid diagnostic hemoglobinometers. The combined hemoglobin concentration and total plasma protein levels suggests additional potential utility in diagnosing dilutional anemia among pregnant women compared to non-pregnant women.
Keywords: New criteria, diagnosis of dilutional anemia, hemoglobin concentration, total plasma protein, pregnant women, non-pregnant women, five hemoglobinometers types