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Erythrocyte indices in the second trimester of pregnancy: are reference values well established? Cristiane C. Bresani I ; Ariani I. The erythrocyte index values in the pregnancy-puerperal cycle behave in a particular manner, however, the physiological or nosological meaning of such alterations are not well established. This study was aimed at analyzing the distribution of erythrocyte indices in the second trimester of pregnancy. The study was carried out with secondary data from pregnant women in the 2nd trimester of low-risk prenatal care at the Instituto Materno Infantil Professor Fernando Figueira Recife, Brazil between May and June

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Erythrocyte indices in the second trimester of pregnancy: are reference values well established? Cristiane C. Bresani I ; Ariani I. The erythrocyte index values in the pregnancy-puerperal cycle behave in a particular manner, however, the physiological or nosological meaning of such alterations are not well established.

This study was aimed at analyzing the distribution of erythrocyte indices in the second trimester of pregnancy. The study was carried out with secondary data from pregnant women in the 2nd trimester of low-risk prenatal care at the Instituto Materno Infantil Professor Fernando Figueira Recife, Brazil between May and June Measurements were performed using an automatic counter. Frequency distribution curves of erythrocyte indices means and standard deviations and correlation curves of hematocrit HTC and hemoglobin Hb concentrations were constructed.

The mean red blood cell number RBC was 3. The mean morphological values were HTC values were three times higher than Hb values. Morphological indices remained within normal ranges, but without delineating a Normal curve. As expected HTC and Hb values behaved following a linear correlation. Key words: Anemia; iron deficiency; prenatal care; erythrocyte indices; pregnancy. Fernando Figueira Recife - Brasil , entre maio de e junho de Threshold erythrocyte indices values define anemia and its classifications, but vary with age, gender and physiological conditions such as pregnancy.

The RBC, HTC and Hb values in the pregnancy-puerperal cycle behave following a physiological curve concavity turned upward , with the lowest point between the 24 th and 28 th weeks of pregnancy and a gradual increase from this point until birth, returning to initial levels in approximately the 6 th week postpartum.

The few studies published state that MCH and MCHC can also undergo significant drops in normal pregnancy, becoming accentuated by the end of the third trimester; and that the MCV undergoes an increase, following the same time sequence, however, do not deviate from ranges normal for healthy women at fertile ages and return to pre-pregnancy levels in the late puerperal period.

Current cutoff points of erythrocyte indices during pregnancy as well are derived from a survey carried out between the s and s on the North American population, therefore, likely do not apply to all populations. This cross-sectional study was based on a secondary databank of a clinical trial.

Subjects who had used medication containing iron in the previous 60 days were excluded. A total of participants with a single, low-risk pregnancy between 16 and 20 weeks were selected. Of these subjects, underwent the hematological examinations analyzed herein. The Anderson-Darling test was used for the compatibility of the variables with Gaussian distribution. Pearson's test was used for the correlation between the HTC and Hb values. Due to the large sample size and the proximity of the mean and median values, the option was made to represent them through means and standard deviations Table 1.

Figure 1 illustrates a linear correlation in which each additional unit of Hb corresponded to 2. From the premise of Gaussian distribution 13 regarding the specific case of anemia, 2. This phenomenon may be explained by a possible emergence of young red blood cells of different sizes and degrees of hemoglobinization, recruited by the high erythropoietic demand of pregnancy. As displayed in Table 2 , studies 4,8, describing erythrocyte indices values in the second trimester of pregnancy generally demonstrate that these values tend not to deviate from ranges considered normal for healthy women at fertile ages.

Milman et al. In the second trimester of pregnancy, the erythrocyte mass indices routinely used in the diagnosis of anemia were, on average, lower than limits considered normal and reproduced Gaussian distribution. The morphological indices remained within ranges considered normal, but did not delineate a Normal curve. There was the expected co-linearity between HTC and Hb values at a ratio Schrier SL.

Excerpted from: approach to the adult patient with anemia. Accessed in Jan Rio de Janeiro: Guanabara Koogan; Yip R. Significance of an abnormally low or high hemoglobin concentration during pregnancy: special consideration of iron nutrition.

Am J Clin Nutr. J Bras Ginecol. Hemoglobin and erythrocyte indices during normal pregnancy and postpartum in women with and without iron supplementation. Acta Obstet Gynecol Scand. Bendell J, Benz Jr. Hematologic changes of pregnancy. In: Hoffman R, Benz Jr. Hematology: basic principles and practice. Florida: Churchill Livingstone; Samuels P. Hematologic complications of pregnancy.

Obstetrics: normal and problem pregnancies. Haematological and biochemical profile of uncomplicated pregnancy in nulliparous women; a longitudinal study.

Neth J Med. Hemoglobin and red cell indices correlated with serum ferritin concentration in late pregnancy. Obstet Gynecol. World Health Organization. Iron deficiency anemia: assessment, prevention and control. A guide for programme managers. Geneve, Switzerland: WHO, Accessed in Jan 9. Recommendations to prevent and control iron deficiency in the United States. Centers for Disease Control and Prevention. Rev Panam Salud Publica. Clin Chem. The quantitative assessment of body iron.

Development of a clinical prediction rule for iron deficiency anemia in pregnancy. Am J Obstet Gynecol. Puolakka J. Serum ferritin as a measure of iron stores during pregnancy. Acta Obstet Gynecol Scand Suppl. Variazione dei livelli di ferritinemia nella gravidanza fisiologica [Variations in ferritin levels in blood during physiological pregnancy]. Minerva Ginecol. Biochemical profile of African American women during three trimesters of pregnancy and at delivery.

J Nutr. HIV and other predictors of serum folate, serum ferritin, and hemoglobin in pregnancy: a cross-sectional study in Zimbabwe. Anemia e ferropenia em gestantes: dissensos de resultados de um estudo transversal. All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License. Services on Demand Journal. Introduction Threshold erythrocyte indices values define anemia and its classifications, but vary with age, gender and physiological conditions such as pregnancy.

Patients and Method This cross-sectional study was based on a secondary databank of a clinical trial. Discussion From the premise of Gaussian distribution 13 regarding the specific case of anemia, 2. References 1. How to cite this article.

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