Changes in the leucocyte formula in pregnant women with a new coronavirus infection, depending on the fact of the presence of thrombogenesis
AbstractDuring the pandemic of a new coronavirus infection, one of the most common complications of the infectious process in patients was the development of hypercoagulation and, as a consequence, the development of thrombogenesis and embolism. Pregnancy period is physiologically accompanied by a decrease in the activity of the immune system and, accordingly, the risk of infection of pregnant women with a new coronavirus infection increases. In addition, physiological pregnancy itself is accompanied by an increased risk of thrombogenesis. Accordingly, the appearance of a new coronavirus infection caused an increase in thrombotic complications in pregnant women, which also adversely affected maternal mortality.
Object of the study. The results of a general clinical blood test of pregnant women infected with the SARS-CoV-2 virus.
The aim of the study was to evaluate the dynamics of the total number of leucocytes and changes in the leucocyte formula in blood against the background of a new coronavirus infection in pregnant women, depending on the day of the disease. To trace the presence or absence of a connection of changes with the process of thrombogenesis.
Material and methods. 99 case histories of patients with a new coronavirus infection who were pregnant during the 3rd trimester of gestation were retrospectively analyzed. All women were divided into 2 groups: the control group included 94 pregnant women in whom no thrombotic complications were recorded. The mean age of patients in the control group was 31.5 [28.0; 35.0] years, the average duration of pregnancy due to the onset of the disease was 34.1 [30.2; 37.6] weeks; the main group included 5 pregnant women who developed thrombotic complications: thrombosis of the veins of the upper and extremities; massive pulmonary embolism, thrombosis of the splenic vein at the hilum of the spleen; left atrial thrombus. The average age of patients in the main group was 33.0 [28.5; 37.5] years, the average duration of pregnancy due to the onset of the disease was 33.2 [30.2; 37.8] weeks. A comparative analysis of the leucocyte formula data was carried out in the group of patients without thrombotic complications and in patients with thrombogenesis. A correlation analysis was also carried out with the day of illness and the days of thrombogenesis.
Results. In both groups of patients during the course of the disease, an increase in the level of the total number of leucocytes was recorded, not exceeding the normal values of Me 8.60×109/l (Q1–Q3 6.85–11.35), more pronounced in the group of women with thrombogenesis [Me 10.55×109/l (Q1–Q3 7.63–13.15)], p=0.001. On the 16th–23rd day of the disease, the median of the total number of leucocytes in the group with thrombosis reached maximum during the disease period [Me 13.00 (Q1–Q3 10.70–15.60)] (p<0.001). The increase in the level of neutrophils was also reflected in their quantitative index (Me 6.60×109/l (Q1–Q3 4.80–8.70) – in the group without thrombogenesis and Me 8.85×109/l (Q1–Q3 6.70–12.15) – in the group with thrombogenesis, p<0.001), and on their percentage ratio (Me 75.10% (Q1–Q3 67.90–82.60) and Me 84.30% (Q1–Q3 78.70–88.50), respectively, p<0.001). The correlation analysis revealed a positive correlation between the absolute number of neutrophils and the days of the disease (r=0.171, p<0.004), more expressed in the group of patients with thrombogenesis (r=0.578, p<0.001). During the study of the percentage of neutrophils in the group of patients without thrombogenesis, a negative correlation with day of disease was recorded (r=-0,242, p<0.001), and in the group of patients with thrombotic complications, a positive correlation relationship (r=0.303, p=0.038). A comparative study of the average number of lymphocytes over the entire observation period in the group of patients with thrombosis revealed lymphopenia (Me 1.00×109/l (Q1–Q3 0.70–1.80)×109/l), and in the group of patients without thrombosis, the number of lymphocytes, although it aspired to the lower limit of the norm, still did not reach the level of lymphopenia at normal median values (Me 1.50×109/l (Q1–Q3 1.10–2.00)×109/l), p<0.001. In the group of patients with thrombogenesis, the lowest lymphocyte counts were recorded on the 12th–15th day of the disease (Me 0.60×109/l (Q1–Q3 0.50–1.00), p<0.001), with a gradual subsequent restoration of the number of lymphocytes by 24 days. When conducting a correlation analysis of the absolute number of lymphocytes with the day of the disease, a positive relationship was established in the group of patients without thrombosis (r=0.454, p<0.001) and in the group of patients with thrombosis (r=0.655, p<0.001). When analyzing the percentage of lymphocytes in both groups, similar data were obtained (r=0.195, p<0.001 – in the group without thrombosis and r=0.460, p<0.001 – in the group of patients with thrombosis).
Conclusion. These studies reflect the dependence of changes in the parameters of the leucoformula on the process of thrombogenesis and can be used in clinical practice to assess the condition of pregnant patients with coronavirus infection and timely measures to prevent the development of thrombotic complications.
Keywords:coronavirus infection; pregnancy; leucocytes; neutrophils; NETosis; lymphocytes; lymphopenia; thrombogenesis
Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
Contribution. All authors contributed equally to the writing and preparation of the manuscript.
For citation: Spiridonova N.V., Gricenko T.A., Khurtova E.F. Changes in the leucocyte formula in pregnant women with a new coronavirus infection, depending on the fact of the presence of thrombogenesis. Akusherstvo i ginekologiya: novosti, mneniya, obuchenie [Obstetrics and Gynecology: News, Opinions, Training]. 2023; 11 (4): 27–34. DOI: https://doi.org/10.33029/2303-9698-2023-11-4-27-34 (in Russian)
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