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 Table of Contents  
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


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 Submission07-May-2021
Date of Acceptance20-Jun-2021
Date of Web Publication7-Sep-2021

Correspondence Address:
Prof. Mathew Folaranmi Olaniyan
Department of Medical Laboratory Science, Edo State University Uzairue, Edo State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bbrj.bbrj_87_21

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  Abstract 


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 2021 Dec 1];5:281-5. Available from: https://www.bmbtrj.org/text.asp?2021/5/3/281/325617




  Introduction Top


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 Top


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 Top


Eighteen percent (36) of the anemic pregnant women had severe anemia whereas 82% (164) had moderate anemia [Table 2], [Figure 1].
Table 1: Sociodemographic characteristics of the participants

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Table 2: Degree of anemia among anemic pregnant women

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Figure 1: Pattern of moderate and severe anemia

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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

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Figure 2: Comparative description of albumin, alanine aminotransferase, creatinine, packed cell volume, and tumor necrosis factor-alpha in anemic and nonanemic pregnant women

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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

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Figure 3: Comparative description of albumin, alanine aminotransferase, creatinine, and tumor necrosis factor-alpha in moderate and severe anemia

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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

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Figure 4: Comparative description of albumin, alanine aminotransferase, creatinine, packed cell volume, and tumor necrosis factor-alpha based on gestational age

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  Discussion Top


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 Top


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.



 
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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