changes in hemoglobin f levels in pregnant women unaffected by clinical fetomaternal hemorrhage.ppt
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Changes in hemoglobin F levelsin pregnant women unaffected
by clinical fetomaternal
hemorrhage
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Introduction
Hemoglobin F (Hb F) is predominantly produced in fetal
life
F cells are measured as the proportion of total red cells
using the KleihauerBetke acid elution method or flow
cytometry
Hb F is measured as a proportion of the total Hb in red
cell lysates by high-performance liquid chromatography
(HPLC)
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Introduction
Complete automation of the HPLC method has made this
procedure available to many clinical laboratories
As a high Hb F level interferes with Hb A1cmeasurements in
some commercially available assay systems [7], Hb F levels
may also be affected by Hb A1c
The physiological changes in %Hb F during pregnancy as
determined by HPLC have not been studied extensively
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Material and methods
All 357 pregnant participants gave birth
between January 2011 and July 2012 at our
institution and were free from clinical
fetomaternal hemorrhage (FMH)
12 (3.4%) were known to be complicated with
diabetes mellitus and 48 (13.4%) were
diagnosed with gestational diabetes mellitus in
the current pregnancy
Total of 490 blood samples from the 357
women were used for simultaneous
determinations of both %Hb F and %Hb A1c
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Material and methods
490 blood
samples from
357 women
Before pregnant (n=21)
1st
trimesters (n=150)
2ndtrimesters (n=116)
3rdtrimesters (n=192)
postpartum (n=11)
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Results
mean %Hb F level during the 1st
trimester did not differ significantly
fromthat determined before pregnancy
Longitudinal
study of 21
women
%Hb F level declined significantly during
pregnancy in the absence of a
significant change in Hb A1c level
Cross-
sectional
study
%Hb F level tended to increase after
delivery (P=0.0667)
Longitudinal
study of 11
women
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Fig. 1. Changes in the %Hb F levels before, during, and
after pregnancy
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Results
the majority of women exhibited a decrease in
%Hb F level and none exhibited an increase in
%Hb F bymore than 0.1%
Women with a higher %Hb F level during the 1st
trimester were significantly more likely to
exhibit a larger decrease in %Hb F during
pregnancy
%Hb F levels : 0.1% to 2.9% with a median valueof 0.7% during the 1sttrimester
%Hb F levels : 0.1% to 2.8% with a median of
0.5% during the 3rdtrimester
An
analysis
of 49
women
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Fig. 2. Longitudinal changes in %Hb F levels
during pregnancy in 49 women
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Fig. 3. Correlation between %Hb F levels during the 1sttrimester and net decreases in %Hb F levels during
pregnancy
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Fig. 4. Distribution of %Hb F levels determined during
the 1st and 3rd trimesters
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Results
A weak but statistically significant negative
correlation between %Hb F and %Hb A1c
levels was observed
Mean %Hb F levels did not differ significantlybetween 475 samples with %Hb A1c level
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Fig. 5. Association between levels of %Hb F and %Hb
A1c in 490 blood samples from 357 women
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Discussion
%Hb F level was highest during the 1st
trimester of pregnancy and declined gradually
toward the 3rd trimester
%Hb F level was significantly increased during
the 1sttrimester compared with those during
the 2nd and 3rd trimesters
The increase in red cells containing Hb F during
the earlier stages of pregnancy has been
suggested to be due to an increased number of
adult F cells
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Discussion
Fetal red cells during the 1st trimester exclusively contain
Hb F, while adult F cells contain both Hb F and Hb AHb
F ranging up to 25% of the total Hb in adult F cells
Hb F accounts for an approximately 10% of the total Hb
in adult F cells
Physiological FMHmay have contributed partly to the
elevation of the 1st trimester Hb F levels
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Discussion
Effect of parity on the Hb F level was not seen in
this study
A significant increase in %Hb F level during the 1st
trimester compared with that before pregnancy
was not confirmed in this study
Although the reason why %Hb F decreases in the
later stages of pregnancy remains to be
determined, it may be due to deceleration of
erythropoiesis during the latter half of pregnancy
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Conclusion
The data presented in this work may be
used as reference intervals of %Hb F
determined with HPLC during
pregnancy
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Thank You
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