Assessment of D-Dimer Levels in Southwestern Nigerian Pregnant Women

Main Article Content

E. O. Bamisaye
M. A. Okungbowa
D. T. Alade
O. Brown- West
G. T. Oluwasuji

Abstract

Aim: This study evaluated D-dimer level in pregnant and non-pregnant women in Southwestern Nigeria in order to provide more information on the concentration and liable risks in this region.

Study Design: This is a cross sectional study where convenience sampling method was applied in sample collection.

Place and Duration of Study: Blood samples were collected from pregnant women             attending the antenatal clinics of Federal Teaching Hospital Ido-Ekiti (FETHI), Ekiti; Federal                Medical Centre (FMC), Owo; and LAUTECH Teaching Hospital (LTH), Osogbo in Southwestern Nigeria.

Methodology: Exactly three hundred pregnant (300) and one hundred and fifty (150) apparently healthy non pregnant women were recruited for this study. The blood samples were analysed for haematocrit (HCT) and platelet count using Sysmex KX-2IN (Japan); prothrombin time (PT) and activated partial thromboplastin time (APTT) by Diagen reagents (Diagnostic Ltd., UK); the international normalized ratio (INR) was calculated from the PT results; and D-dimer quantitative assay using Tina Quant Gen 2 on Cobas C111 (Roche). Data analysis was performed using IBM-SPSS version 25.0; mean and standard deviation was used to summarize continuous variables and descriptive and Inferential statistical tests were employed with level of statistical significance was determined at p<0.05.

Results: The mean D-dimer levels were significantly higher in the pregnant women (0.87 ± 1.00 ugFEU/ml) than in controls (0.31 ± 0.22 ugFEU/ml) with 42% of the pregnant population having elevated concentration while the mean PT, INR and HCT were significantly higher in controls than the subjects (p<0.05).Furthermore, the HCT, platelet, PT and INR were observed to be highest at first trimester; 36.04±5.09 (L/L), 182.72±35.11 (x109/L), 11.80±1.86 (seconds) and 0.35±0.15 respectively, decreasing across the second and the third trimester. On the other hand, the D-dimer and APTT increased exponentially from the first trimester; 0.42±0.18 (ugFEU/ml) and 30.80±3.30 (seconds), through the second and third trimesters respectively (p>0.05).

Conclusion: This study shows a significant increase in D-dimer in the pregnant subjects when compared with the control and an exponential increase in the third trimester, also a significant reduction in some other baseline coagulation profile hence depicting D-dimer as a notable significant marker of coagulation and fibrinolysis. This therefore emphasizes the hypercoagulable state of pregnancy and a need for adequate monitoring.

Keywords:
D-dimer levels, pregnant women, blood samples, coagulation and fibrinolysis.

Article Details

How to Cite
Bamisaye, E. O., Okungbowa, M. A., Alade, D. T., West, O. B.-, & Oluwasuji, G. T. (2020). Assessment of D-Dimer Levels in Southwestern Nigerian Pregnant Women. Advances in Research, 21(9), 60-68. https://doi.org/10.9734/air/2020/v21i930233
Section
Original Research Article

References

Practical Hemostasis.com: A practical guide to haemostasis. Sang Medicine; 2020.

Available:https://practical-haemostasis.com

Johnson ED, Schell JC, George MR. The D-dimer assay. American Journal of Haematology. 2019;94:833-839.

Johnson ED, Schell JC, Rodgers GM. Clinical pearls in blood diseases: The D‐dimer assay. American Journal of Haematology. 2019;94(7):833-839.

DOI: 10.1002/ajh.25482

Aguilar C, del Villar V. Combined D-dimer and clinical probability are useful for exclusion of recurrent deep venous thrombosis. American Journal Hematology. 2007;82(1):41-44.

Wells PS, Anderson DR, Rodger M. Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis. Nigerian England Journal Medicine. 2013;349: 1227–1235.

Osunkalu VO, Adeoye FA, Akinsola OJ, Makwe CC. Plasma D-dimer reference ranges in pregnant Nigerians. Afr J Med Med Sci. 2014;43(3):273-8.

Jeremiah ZA, Adias TC, Opiah M, George SP, Mgbere O, Essien EJ. Elevation in D-dimer concentrations is positively correlated with gestation in normal uncomplicated pregnancy. Int J Womens Health. 2012;4:437-443.

DOI: 10.2147/ijwh.s32655

Udomah FP, Isah IZ, Hassan M, John RT, Erhabor O, et al. D-dimer levels among pregnant women of African descent attending antenatal clinic in a tertiary hospital in Sokoto, North Western Nigeria. Jacobs Journal of Haematology. 2015;1(1):008.

Edelstam G, Lowbeer C, Kral G, Gustafsson SA, Venge P. New reference values for routine blood samples and human neutrophilic lipocalin during third-trimester pregnancy. Scand J Clin Lab Invest. 2001;61(8):583-592.

Choi JW, Pai SH. Tissue plasminogen activator levels change with plasma fibrinogen concentrations during pregnancy. Ann Hematol. 2002;81(11): 611-615.

DOI: 10.1007/s00277- 002-0549-1

Zaini R, Al-Rehaili A, Kufia R. Evaluation of plasma D-dimer concentration among normal and complicated pregnancies, Saudi Arabia. International Journal of Women’s Health and Reproduction Sciences. 2019;7(1):17–23.

Einass AA, Marwa GA, Mozdalifa OA, Ashgan AO. Coagulation parameters, platelet count and D-dimer level changes in Preeclampsia and normal pregnancies in Khartoum State. European Journal of Biomedical and Pharmaceutical Sciences. 2017;4(3):60-64.

Hellgren M. Hemostasis during normal pregnancy and puerperium. Semin Thromb Hemost. 2003;29(2):125–130.

Jivraj S, Makris M, Saravelos S, Li T. Pregnancy outcome in women with factor V Leiden and recurrent miscarriage. British Journal of Obstetrics and Gynecology. 2009;78:234-246.

Palta S, Saroa R, Palta A. Overview of the coagulation system. Indian J Anaesth. 2014;58(5):515–523.

DOI: 10.4103/0019-5049.144643

Hayward CP. Diagnostic approach to platelet function disorders. Transfus Apher Sci. 2008;38(1):65-76.

Palareti G, Cosmi B, Legnani C, et al. D-dimer testing to determine the duration of anticoagulation therapy. N Engl J Med. 2006;355:1780–1789.

Curry N, Keeling D. Venous thromboembolism: The role of the clinician. Journal of American Medicine. 2009;39: 243–246.

Eichinger S. D-dimer testing in pregnancy. Journal of Pathophysiology Haemostasis and Thrombosis. 2013;33:327–329.

National Population Commission (Nigeria) and ICF International. Nigeria Demographic and Health Survey 2013: National Population Commission and ICF International; 2014.

Gerbasi FR, Bottoms S, Farag A, Mammen E. Increased intravascular coagulation associated with pregnancy. Obstetrics and Gynecology. 1990;75:385-389.

Robinson S, Bewley S, Hunt BJ, Radia DH, Harrison CN. The management and outcome of 18 pregnancies in women with polycythemia vera. Haematologica. 2005;90:1477-1483.

Taylor FB, Peer GT, Lockhart MS, Ferrell G, Esmon CT. Endothelial cell protein C receptor plays an important role in protein C activation in vivo. Blood. 2001;97:1685–1688.

World Health Organization. Maternal mortality. Fact Sheets; 2018.

Available:https://www.who.int/news-room/fact-sheets/detail/maternal-mortality

Nwokocha EE. Maternal crises and the role of African men: The case of Nigerian Community. African Journal of Population Studies. 2008;22(1).

Elem M, Nyeche S. Health inequality and the empowerment of reproductive age of women for development in Rivers State primary health care strategy in the reduction of maternal mortality (2007-2015). International Journal of Advanced Academic Research. Social and Management Sciences. 2016;2(11).

Filippi V, Chou D, Ronsmans C, et al. Levels and causes of maternal mortality and morbidity. In: Black RE, Laxminarayan R, Temmerman M, et al., Editors. Reproductive, Maternal, Newborn, and Child Health: Disease Control Priorities, Third Edition (Volume 2). Washington (DC): The International Bank for Reconstruction and Development / The World Bank. 2016;Chapter 3.

Available:https://www.ncbi.nlm.nih.gov/books/NBK361917/

DOI: 10.1596/978-1-4648-0348-2_ch3

Say L, Chou D, Gemmill A, Tuncalpo O, Moller A-B, et al. Global causes of maternal death: A WHO systematic analysis. The Lancet Global Health. 2014;2(6):e323–33.