Rezumat
Background: The use of D-dimer as a screening test for thromboembolic disorders has not been validated in pregnancy thus necessitating further studies. This cross sectional study was carried out among Pregnant Nigerians at the Nigerian Air Force Hospital Ante-natal Clinic, Ikeja, Lagos.
Objective: This study was to determine local reference ranges for plasma D-dimer in both pregnant and nonpregnant females and compare differences in both populations.
Methods: Structured questionnaires were administered on a total of 365 participants which included 71 apparently healthy non-pregnant females, 64 women in the first trimester of pregnancy (<13 weeks gestation); 65 women at the second trimester of pregnancy (14-26 weeks), and 82 pregnant females at the third trimester of pregnancy (>=27 weeks). Citrated blood was collected for estimation of prothrombin time (PT), activated partial thromboplastin time (aPTT), and D-dimer estimation by ELISA method. Aspartate aminotransferase (AST) and alanine aminotransferase enzymes (ALT) were estimated using the Hitachi chemistry analyzer. Reference ranges were estimated non-parametrically using the Reference Value Advisor V 2.1.
Results: Median D-dimer level for non-pregnant females was 190ng/mL, while the median D-dimer levels for pregnant female in 1st, 2nd, and 3rd trimester were 485ng/ml; 620ng/mL; and 1185ng/mL respectively.Reference ranges were calculated to be 86-494ng/mL; 338-624ng/mL; 451-799ng/mL and 665-1262ng/mL for nonpregnant females, 1st, 2nd, and 3rd trimester of pregnancy respectively.
Conclusion: A diagnostic algorithm for venous thromboembolism (VTE) in pregnant women which combines clinical suspicion with elevated plasma D-dimers levels above estimated reference range for each trimester should precede definitive formal imaging. Keywords: D-dimer, Venous thromboembolism, Pregnancy.
Résumé
Introduction: L’emploi du D-dimer comme un crible réactif pour les désordres thromboemboliques n’a pas été validé dans la grossesse ainsi nécessitant des études ultérieures. Cette étude à cross-section était menée parmi les Nigérianes Enceintes à la Clinique Anténatalede l’Hôpital des Forces de l’Armée de l’Air Nigériane, Ikeja, Lagos.
Objective: Cette étude était pour déterminer les ranges de référence locale pour le plasma D-dimer dans les deux groupes de femmes enceintes et non-enceintes et compare les différencesdans les deux populations.
Méthode: Questionnaires structurés étaient administrés sur un total de 365 participants qui comprenait apparemment 71 femmes nonenceintes saines, 64 femmes dans leurs premier trimestre de grossesse (13 semaines de gestation); 65 femmes a leurs deuxième trimestre de grossesse (14-26 semaines), et 82 femmes enceintes a leurs troisième trimestre de grossesse (27 semaines). Sang citrate était recueilli pour estimation de temps prothrombine (TP), temps thromboplastine partiel activé (TTPa), et estimation D-dimer par la méthode ELISA. Amino-transférase aspartique (ATS) et enzymes Amino-transférase alanine (ALT) étaient estimés en utilisant l’analyseur chimie Hitachi. Les ranges de référence étaient estimées non-paramétriques en utilisant le Conseiller de Valeur Référence V 2.1.
Résultats: Le niveau médian D-dimer pour les femmes non-enceintes était 190ng/mL, tandis que les niveaux médian D-dimer pour les femmes enceintes dans le 1er, 2eme, 3eme trimestre étaient respectivement 485ng/mL, 620ng/mL, et 1185ng/mL. Les ranges de référence étaient calculées a être 86-494ng/mL, 338-624ng/mL, 451-799ng/mL et 665-1262ng/mL pour les femmes non-enceintes, 1 er, 2eme, 3eme trimestre de grossesse respectivement.
Conclusion: Un algorithme diagnostique pour VTE dans les femmes enceintes qui combine suspicion clinique avec niveaux de plasma D-dimer élevées au dessus des ranges de référence estimées pour chaque trimestre devrait précéder l’image formelle définitive.
Mots clés : D-dimer, Thrombose-embolisme veineuse, Grossesse.
Correspondence: Dr. V.O. Osunkalu, Department of Haematology and Blood Transfussion, College of Medicine, University of Lagos. Lagos, Nigeria. E-mail: osunkalu@gmail.com; doctorvincent@yahoo.com.
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