|
 
 |
| ORIGINAL ARTICLE |
|
| Year : 2021 | Volume
: 5
| Issue : 3 | Page : 281-285 |
|
Inflammatory response, plasma albumin, creatinine, alanine aminotransferase, and packed cell volume in relationship with the degree of anemia and gestational age in HbAA anemic pregnant women
Mathew Folaranmi Olaniyan1, Musa Abidemi Muhibi1, Kehinde Abiola Babatunde2
1 Department of Medical Laboratory Science, Edo State University, Uzairue, Edo State, Nigeria
2 Department of Medical Laboratory Science, Kwara State University, Malete, Nigeria
| Date of Submission | 07-May-2021 |
| Date of Acceptance | 20-Jun-2021 |
| Date of Web Publication | 7-Sep-2021 |
Correspondence Address:
Prof. Mathew Folaranmi Olaniyan
Department of Medical Laboratory Science, Edo State University Uzairue, Edo State
Nigeria
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/bbrj.bbrj_87_21
Background: Anemia in pregnancy which may be mild, moderate, or severe is a common physiological disorder that can lead to poor pregnancy outcome which may be primary or secondary to problems associated with hepatic, renal, and immune system which may be indicated by alterations in packed cell volume (PCV), alanine transaminase, albumin, tumor necrosis factor-alpha (TNF-α), and creatinine. This work is, therefore, designed to determine inflammatory response, plasma albumin, creatinine, alanine aminotransferase (ALT), and PCV in relationship with the degree of anemia and gestational age in anemic pregnant women. Methods: Two hundred (200) HbAA anemic pregnant women and 100 nonanemic pregnant women were recruited as test and control subjects, respectively. All subjects were negative to HIV-Ag-Ab, acid-fast bacillus (AFB)-Ziehl–Neelsen, Plasmodium, anti-hepatitis C virus (HCV), and hepatitis B envelope antigen (HBeAg) tests. HIV-Ag-Ab, TNF-α, anti-HCV, and HBeAg were determined by enzyme-linked immunosorbent assay; AFB by Ziehl–Neelsen staining; Plasmodium by thick-film Giemsa staining; hemoglobin types by hemoglobin electrophoresis; albumin, creatinine, and ALT by auto-chemistry analysis using COBAS C11; and PCV by microhematocrit tube method. Results: Eighteen percent (36) of the anemic pregnant women had severe anemia whereas 82% (164) had moderate anemia. The results obtained showed a significant increase in the plasma value of TNF-α and a decrease in the PCV in anemic pregnant women compared with the results obtained in the nonanemic pregnant women (P < 0.05). There was a significant increase in plasma TNF-α in severe anemia compared with the anemic pregnant women with moderate anemia (P < 0.05). Conclusions: This work revealed a significant increase in plasma TNF-α and a decrease in PCV in anemic pregnant women which was more intense in anemic pregnant women with severe anemia while the pattern of anemia showed that 18% (36) of the anemic pregnant women had severe anemia whereas 82% (164) had moderate anemia.
Keywords: Acid-fast bacilli, alanine aminotransferase, albumin, anemia in pregnancy, packed cell volume, anti-hepatitis C virus, creatinine, hepatitis B envelope antigen, HIV-Ag-Ab, Plasmodium, tumor necrosis factor-alpha
How to cite this article:
Olaniyan MF, Muhibi MA, Babatunde KA. Inflammatory response, plasma albumin, creatinine, alanine aminotransferase, and packed cell volume in relationship with the degree of anemia and gestational age in HbAA anemic pregnant women. Biomed Biotechnol Res J 2021;5:281-5 |
How to cite this URL:
Olaniyan MF, Muhibi MA, Babatunde KA. Inflammatory response, plasma albumin, creatinine, alanine aminotransferase, and packed cell volume in relationship with the degree of anemia and gestational age in HbAA anemic pregnant women. Biomed Biotechnol Res J [serial online] 2021 [cited 2023 Mar 23];5:281-5. Available from: https://www.bmbtrj.org/text.asp?2021/5/3/281/325617 |
| Introduction | |  |
Anemia is a health defect in which the level of the red blood cells in the body is low which may reduce oxygen supply to tissues.[1],[2],[3],[4],[5],[6],[7],[8],[9] It may be temporary or long-term, mild, moderate, or severe and may also be acute or chronic. Anemia is diagnosed through laboratory procedures by measuring the hemoglobin concentration or packed cell volume (PCV). A woman is diagnosed to be anemic when the hemoglobin concentration is <12 g/dL whereas anemia in pregnancy is diagnosed when the hemoglobin levels <11 g/dL during the first trimester, <10.5 g/dL during the second and third trimesters, and <10 mg/dL in the postpartum period.[1],[2],[3],[4],[5],[6],[7],[8],[9]
Anemia is caused by impaired production, increased destruction, blood loss, fluid overload, and intestinal inflammation.[1],[2],[3],[4],[5],[6],[7],[8],[9] The iron requirement in pregnancy is almost twice as much iron as women need when they are not pregnant. Pregnancy is associated with hormonal changes that may result into an increase in blood volume, plasma volume increases.[1],[2],[3],[4],[5],[6],[7],[8],[9]
Erythropoietin is a hormone required for erythropoiesis. Erythropoietin is produced by the kidney.[10],[11],[12],[13],[14],[15],[16],[17],[18],[19] Erythropoietin, or hematopoietin, or hemopoietin, is a glycoprotein cytokine secreted, mainly by the kidney in response to cellular hypoxia;[20] it stimulates red blood cell production in the bone marrow.[10],[11],[12],[13],[14],[15],[16],[17],[18],[19] Renal disease can affect the production of erythropoietin causing a reduction in the blood level.[10],[11],[12],[13],[14],[15],[16],[17],[18],[19] Reduction in erythropoietin can lead to anemia which is indicated by low hemoglobin concentration or PCV.[10],[11],[12],[13],[14],[15],[16],[17],[18],[19]
Elevated plasma creatinine is a good indicator of renal disease. Creatinine is easily measured and a byproduct of muscle metabolism excreted unchanged by the kidneys.[2],[21],[22],[23] Albumin is a transport protein produced in the liver. It is a negative acute-phase protein whose plasma level decreases upon inflammation. A decrease in albumin may be caused by liver disease causing a decrease in the synthetic function.[24] Tumor necrosis factor-alpha (TNF-α) is an inflammatory cytokine that regulates immune cells.[25],[26],[27],[28] It acts as an endogenous pyrogen to induce fever, apoptotic cell death, and inflammation. The cytokine inhibits tumorigenesis, viral replication, and response to sepsis because when there is an infection, macrophages release TNF-α to alert other immune system cells as part of an inflammatory response.[25],[26],[27],[28]
Alanine transaminase is a liver enzyme of which the elevated level can be an indication of hepatocellular damage.[29] Liver and spleen are the sites for extramedullary erythropoiesis.[29] The enzyme is found in plasma and in various body tissues but is most common in the liver. The enzyme catalyzes transamination reaction involving the transfer of an amino group from L-alanine to α-ketoglutarate to form pyruvate and L-glutamate.[29]
| Methods | | |
Study area
This work was carried out in the antenatal clinics in government hospitals, Ilorin. Ilorin is the capital city of Kwara state. It is a multilingual/ethnic ancient city. Ilorin has primary, secondary, and tertiary health and educational institutions.
Sample population
Two hundred (200) anemic pregnant women and 100 nonanemic pregnant women were recruited as test and control subjects, respectively. All subjects were negative to HIV-Ag-Ab, acid-fast bacillus (AFB)-Ziehl–Neelsen, Plasmodium, anti-HCV, and hepatitis B envelope antigen (HBeAg) tests.
Biological specimen
Five milliliters of venous blood sample was obtained from each of the subjects and preserved in lithium-heparinized bottles. Blood plasma was extracted from the whole blood for the assay of alanine aminotransferase (ALT), creatinine, TNF-α, and albumin. Sputum was obtained from the subjects for AFB test.
Laboratory methods
Plasma creatinine, alanine aminotransferase, and albumin
These parameters were measured using an auto-chemistry analyzer – COBAS C11 using Roche reagent.
Hepatitis B envelope antigen enzyme-linked immunosorbent assay
HBeAg, a marker of hepatitis B virus infection, was determined in the subjects by enzyme immunoassay using the reagent kit of DIA.PRO Diagnostic Bioprobes Srl Via Columella, Milano, Italy. Manufacturer's instructions were strictly followed and applied.
HIVp24 antigen and antibody enzyme-linked immunosorbent assay
HIVp24 antigen and antibody was tested in the subjects using Bio-Rad Genscreen™ ULTRA HIV Ag-Ab qualitative enzyme immunoassay kit. Manufacturer's instructions were strictly followed and applied.
Anti-hepatitis C virus enzyme-linked immunosorbent assay
Anti-HCV test was tested in the subjects using a third-generation enzyme immunoassay reagent kit of DIA.PRO Diagnostic Bioprobes Srl Via Columella, Milano, Italy. Manufacturer's instructions were strictly followed and applied.
Tumor necrosis factor-alpha enzyme-linked immunosorbent assay
Plasma TNF-α was tested in the subjects by enzyme-linked immunosorbent assay (ELISA) using Human ABCAM ELISA Kit. Manufacturer's instructions were strictly followed and applied.
Hemoglobin electrophoresis, detection of acid-fast bacilli in sputum, and identification of Plasmodium in blood
Hemoglobin electrophoresis, AFB in sputum, and identification of Plasmodium in blood were determined in the subjects by the method described by Cheesbrough.[30]
Ethical consideration
The proposal was reviewed by the Research and Ethics Committee of the Kwara State Ministry of Health, Ilorin, and approved before the commencement of the work (MOH/KS/EU/777/470). Informed consent was also obtained from each subject.
Statistical analysis
The raw data were subjected to statistical analysis using SPSS 20.0 (SPSS 20.0 IBM, New York ) to determine mean, standard deviation, frequency, odds ratio, “t-” test, and probability value at 0.05 level of significance.
| Results | | |
Eighteen percent (36) of the anemic pregnant women had severe anemia whereas 82% (164) had moderate anemia [Table 2], [Figure 1].
The results obtained showed a significant increase in the plasma value of TNF-α and a decrease in the PCV in anemic pregnant women compared with the results obtained in the nonanemic pregnant women [P < 0.05, [Table 3] and [Figure 2]]. | Table 3: Comparative analysis of plasma albumin, alanine aminotransferase creatinine, and packed cell volume in anemic and nonanemic pregnant women
Click here to view |
 | Figure 2: Comparative description of albumin, alanine aminotransferase, creatinine, packed cell volume, and tumor necrosis factor-alpha in anemic and nonanemic pregnant women
Click here to view |
There was no significant difference in the plasma value of albumin (g/L), ALT (IU/L), and creatinine (mmol/L) in anemic and nonanemic pregnant women [P > 0.05; [Table 3] and [Figure 2].
There was no significant difference in the plasma value of albumin, ALT, and creatinine in moderate and severe anemia [P > 0.05; [Table 4] and [Figure 3]]. There was a significant increase in plasma TNF-α in severe anemia compared with the anemic pregnant women with moderate anemia [P < 0.05; [Table 4] and [Figure 3]]. | Table 4: Comparative analysis of plasma albumin, alanine aminotransferase, and creatinine based on the degree of anemia
Click here to view |
 | Figure 3: Comparative description of albumin, alanine aminotransferase, creatinine, and tumor necrosis factor-alpha in moderate and severe anemia
Click here to view |
There was no significant difference in the plasma albumin, ALT, creatinine, TNF-α, and PCV based on the gestational age [P > 0.05; [Table 5] and [Figure 4]]. Sociodemographic characteristics of the participants is as shown in [Table 1]. | Table 5: Comparative analysis of albumin, alanine aminotransferase, creatinine, and packed cell volume based on gestational age
Click here to view |
 | Figure 4: Comparative description of albumin, alanine aminotransferase, creatinine, packed cell volume, and tumor necrosis factor-alpha based on gestational age
Click here to view |
| Discussion | | |
This work examined that 18% (36) of the anemic pregnant women had severe anemia whereas 82% (164) had moderate anemia. The frequency of severe anemia among the pregnant women in this work in Ilorin, North Central Nigeria, was higher than the prevalence 6.7% reported by Oboro et al.[31] in South Southern Nigeria, 1.9% reported by Idowu et al.[32] in South West Nigeria, and 12.9% reported by Ukibe et al.[33] in South East Nigeria. This work also found that 82% (164) of the anemic pregnant women had moderate anemia which was also higher than 36.4% reported by Ukibe et al.[33] in South East Nigeria and 40.3% reported by Idowu et al.[32] in South West Nigeria.
These differences may be attributed to regional differences in socioeconomic factors, nutritional differences as it affects food supplements as iron-deficiency folate and Vitamin B12 deficiencies are major causes of anemia in pregnancy.[1],[2],[3],[4],[5],[6],[7],[8],[9] (Mitchell RS et al ,2005).[1]
The results obtained showed a significant increase in the plasma value of TNF-α in anemic pregnant women compared with the results obtained in the nonanemic pregnant women.
This can be associated with the report that TNF-α is involved in inducing inflammatory anemia.[34] This is because elevated TNF-α has a significant association with pregnancy as Salama et al.[35] reported a significantly higher concentration of TNF-α and interleukin-1β in the pregnant group than the nonpregnant group.
The results obtained showed a significant decrease in the PCV in anemic pregnant women compared with the results obtained in the nonanemic pregnant women. This can be associated with anemia as anemia is characterized by low PCV. This can also be attributed to the fact that pregnancy is associated with hormonal changes that may result into an increase in blood volume, plasma volume increases.[1],[2],[3],[4],[5],[6],[7],[8],[9]
There was a significant increase in plasma TNF-α in severe anemia compared with the anemic pregnant women with moderate anemia. This can also be attributed to the fact that pregnancy is associated with hormonal changes that may result into an increase in blood volume, plasma volume increases.[36]
| Conclusion | | |
This work revealed a significant increase in plasma TNF-α and a decrease in PCV in anemic pregnant women which was more intense in anemic pregnant women with severe anemia while the pattern of anemia showed that 18% (36) of the anemic pregnant women had severe anemia whereas 82% (164) had moderate anemia.
Ethical statement
The proposal was reviewed by the Research and Ethics Committee of the Kwara State Ministry of Health, Ilorin, and approved before the commencement of the work (MOH/KS/ EU/777/470). Informed consent was also obtained from each subject.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Mitchell RS, Kumar V, Abbas AK, Fausto N. Robbins Basic Pathology. 8 th ed. Philadelphia: Saunders; 2007. p. 432.  |
| 2. | Cotran RS, Kumar V, Fausto N, Robbins SL, Abbas AK. Robbins and Cotran Pathologic Basis of Disease. St. Louis, Mo: Elsevier Saunders; 2005. p. 637. |
| 3. | Berentsen S, Beiske K, Tjønnfjord GE. Primary chronic cold agglutinin disease: An update on pathogenesis, clinical features and therapy. Hematology 2007;12:361-70. |
| 4. | Brooker S, Hotez PJ, Bundy DA. Hookworm-related anaemia among pregnant women: A systematic review. PLOS Negl Trop Dis 2008;2:e291. |
| 5. | Gyorkos TW, Gilbert NL, Larocque R, Casapía M. Trichuris and hookworm infections associated with anaemia during pregnancy. Trop Med Int Health 2011;16:531-7. |
| 6. | Whitehead NS, Williams LO, Meleth S, Kennedy SM, Ubaka-Blackmoore N, Geaghan SM, et al. Interventions to prevent iatrogenic anemia: A laboratory medicine best practices systematic review. Crit Care 2019;23:278. |
| 7. | Martin ND, Scantling D. Hospital-acquired anemia. J Infus Nurs 2015;38:330-8. |
| 8. | Verma S, Cherayil BJ. Iron and inflammation – The gut reaction. Metallomics 2017;9:101-11. |
| 9. | Guagnozzi D, Lucendo AJ. Anemia in inflammatory bowel disease: A neglected issue with relevant effects. World J Gastroenterol 2014;20:3542-51. |
| 10. | Leffler DA, Green PH, Fasano A. Extraintestinal manifestations of coeliac disease. Nat Rev Gastroenterol Hepatol 2015;12:561-71. |
| 11. | Stein J, Connor S, Virgin G, Ong DE, Pereyra L. Anemia and iron deficiency in gastrointestinal and liver conditions. World J Gastroenterol 2016;22:7908-25. |
| 12. | Catassi C, Bai JC, Bonaz B, Bouma G, Calabrò A, Carroccio A, et al. Non-Celiac Gluten sensitivity: The new frontier of gluten related disorders. Nutrients 2013;5:3839-53. |
| 13. | James SP. National institutes of health consensus development conference statement on celiac disease, June 28-30, 2004. Gastroenterology (Review) 2005;128 4 Suppl 1:S1-9. |
| 14. | Lomer MC. Dietary and nutritional considerations for inflammatory bowel disease. Proc Nutr Soc 2011;70:329-35. |
| 15. | Gerasimidis K, McGrogan P, Edwards CA. The aetiology and impact of malnutrition in paediatric inflammatory bowel disease. J Hum Nutr Diet 2011;24:313-26. |
| 16. | Beutler E, Waalen J. The definition of anemia: What is the lower limit of normal of the blood hemoglobin concentration? Blood 2006;107:1747-50. |
| 17. | Momaya A, Fawal M, Estes R. Performance-enhancing substances in sports: A review of the literature. Sports Med 2015;45:517-31. |
| 18. | Elliott S, Sinclair AM. The effect of erythropoietin on normal and neoplastic cells. Biologics 2012;6:163-89. |
| 19. | Hosseini-Zare MS, Dashti-Khavidaki S, Mahdavi-Mazdeh M, Ahmadi F, Akrami S. Peripheral neuropathy response to erythropoietin in type 2 diabetic patients with mild to moderate renal failure. Clin Neurol Neurosurg 2012;114:663-7. |
| 20. | Lewis SM, Dirksen SR, Heitkemper MM, Bucher L, Harding M. Medical-Surgical Nursing: Assessment and Management of Clinical Problems. 9 th ed. St. Louis: Missouri; 2013. |
| 21. | Allen PJ. Creatine metabolism and psychiatric disorders: Does creatine supplementation have therapeutic value? Neurosci Biobehav Rev 2012;36:1442-62. |
| 22. | Hosten AO, Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3 rd ed. Boston: Butterworths; 1990. |
| 23. | McDonald T, Drescher KM, Weber A, Tracy S. Creatinine inhibits bacterial replication. J Antibiot 2012;65:153-6. |
| 24. | Sugio S, Kashima A, Mochizuki S, Noda M, Kobayashi K. Crystal structure of human serum albumin at 2.5 A resolution. Protein Eng 1999;12:439-46. |
| 25. | Heir R, Stellwagen D. TNF-mediated homeostatic synaptic plasticity: From in vitro to in vivo models. Front Cell Neurosci 2020;14:565841. |
| 26. | Gough P, Myles IA. Tumor necrosis factor receptors: Pleiotropic signaling complexes and their differential effects. Front Immunol 2020;11:585880. |
| 27. | Rolski F, Błyszczuk P. Complexity of TNF-α signaling in heart disease. J Clin Med 2020;9:3267. |
| 28. | Probert L. Forward and reverse signaling mediated by transmembrane tumor necrosis factor-alpha and TNF receptor 2: Potential roles in an immunosuppressive tumor microenvironment. Front Immunol 2017;8:1675. |
| 29. | Giannini EG, Testa R, Savarino V. Liver enzyme alteration: A guide for clinicians. CMAJ 2005;172:367-79. |
| 30. | Cheesbrough M. District Laboratory Practice in Tropical Countries. Part. 2., 2 nd ed. New York: Cambridge University Press The Edinburgh Building, Cambridge CB2 8RU, UK Published in the United States of America by Cambridge University Press; 2006. |
| 31. | Oboro VO, Tabowei TO, Jemikalajah J. Prevalence and risk factors for anaemia in pregnancy in South Southern Nigeria. J Obstet Gynaecol 2002;22:610-3. |
| 32. | Idowu OA, Mafiana CF, Dapo S. Anaemia in pregnancy: A survey of pregnant women in Abeokuta, Nigeria. Afr Health Sci 2005;5:295-9. |
| 33. | Ukibe Solomon N, Ikeako Lawrence C, Mbanugo James I, Obi- Okaro Alphonsus C, Ukibe Nkiruka R. Prevalence of anaemia in pregnant women attending antenatal clinics in Anambra state South- Eastern Nigeria. Int J Adv Res 2013;1:65-9. |
| 34. | Lucendo AJ, Roncero O, Serrano-Duenas MT, Hervías D, Alcázar LM, Miriam Ruiz-Ponce, et al. Effects of anti–TNF-alpha therapy on hemoglobin levels and anemia in patients with inflammatory bowel disease. Dig Liver Dis 2020;52:400-7. |
| 35. | Salama KM, Alloush MK, Al hussini RM. Are the cytokines TNF alpha and IL 1Beta early predictors of embryo implantation? Cross sectional study. J Reprod Immunol 2020;137:102618. |
| 36. | Cavaillon JM. Pro- versus anti-inflammatory cytokines: Myth or reality. Cell Mol Biol (Noisy-le-grand) 2001;47:695-702. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]
|
Search Pubmed for