Hematological Changes in Pregnancy-induced Hypertension

Background: Pregnancy-induced hypertension (PIH) is the most common medical disorder of pregnancy contributing significantly to maternal/fetal morbidity and mortality. Hemostatic abnormalities that range from thrombocytopenia, consumption coagulopathy to hemolysis, elevated liver enzymes, and low platelets (HELLP) are the most ominous complications seen. This study was taken to evaluate the nature of these special hematological abnormalities in PIH. Materials and Methods: A total 200 patients with clinical diagnosis of PIH referred to the department of pathology for hematologic evaluation over a period of 11⁄2 year were included in the study. Complete hemogram, routine urine examination, and aspartate aminotransferase/alanine aminotransferase were done in all patients. Coagulation tests such as prothrombin time activated partial thromboplastin time, thrombin time, and D-dimer were carried out only in patients with thrombocytopenia (platelet count <1.5 lakhs), i.e., on 42 patients. Results: Around 112 patients were grouped as severe PIH and 88 patients were grouped as mild PIH. Five of the severe PIH patients and only one of the mild PIH patient progressed toward HELLP syndrome. Useful parameters in the hemogram were blood picture to indicate microangiopathic hemolytic anemia, consumption coagulopathy, reticulocytosis, and leukocytosis which helped to identify the need for early initiation of specific therapy. The D-dimer test along with the platelet count was useful in predicting impending disseminated intravascular coagulation. HELLP syndrome with its grave prognosis was identified in 6 patients using blood picture and elevated liver enzymes. Conclusion: This study shows that repeated hemogram and study of blood smear can go a long way toward identifying patients who are likely to go in for one or the other complications of PIH and identify those requiring specific component therapy by undertaking coagulation studies in a certain percentage of these patients.