Immature Platelet Fraction as a Predictive Marker of Severity in Hypertensive Disease of Pregnancy: a Prospective Cross-Sectional Study

Objective: This study aimed to evaluate the role of immature platelet fractions (IPFs) and the degree of thrombocytopenia and their association with the severity of hypertensive disease of pregnancy.Material and Methods: One-hundred-and-ten primigravida females between 20-30 years of age, with a singleton live pregnancy, who attended the ANC clinic at Mahila Chikitsalaya, at over 20 weeks of gestation, with hypertensive disease of pregnancy, from November 2019 to August 2021, were enrolled in the study. Blood samples were obtained from all subjects  at a regular ANC visits and at the time of admission in hypertensive disease of pregnancy and  samples were analyzed within 4 hours of collection using an automated hematology system. IPFs were quantified using an optical fluorescence method. The levels of thrombocytopenia and immature platelet fractions were statistically analyzed against the severity of the disease.Results: The mean IPF was highest in females with eclampsia (18.12±3.59%), followed by severe preeclampsia (14.81±2.91%), mild preeclampsia (10.55±3.26%) and was smallest in females with gestational hypertension (10.08± 0.91%). This increase in IPF with increasing severity of hypertensive disorder of pregnancy was found to be statistically significant (p-value<0.001). The mean platelet count was lowest in females with eclampsia (1.60±0.41 lac/mm3, followed by severe pre-eclampsia (1.65±0.36 lac/mm3), mild pre-eclampsia (1.90±0.47 lac/mm3) and highest in females with gestational hypertension (2.57±0.25 lac/mm3) (p-value<0.001)Conclusion: Higher IPFs had a negative correlation with lower platelet counts and was significantly correlated s with disease severity. Changes in IPF in HDP may occur before development of thrombocytopenia, thus providing an opportunity to plan preemptive management strategies to reduce fetomaternal morbidity and mortality.