Development of a Novel Early Diagnostic Criteria for Dilutional Anemia using Maternal Total Plasma Protein Levels and Hemoglobin Concentrations in Pregnant Women Attending Antenatal Clinic at University of Calabar Teaching Hospital, Calabar

Abstract

Background: Dilutional anaemia has been hypothesized to be a common complication in pregnancy usually characterized by decreased hemoglobin concentration due to increased blood volume and changes in maternal total plasma protein levels. However, accurate measurement of combined hemoglobin and total plasma protein levels are yet to be recognized by researchers as early new diagnostic criteria parameters for its management and differentiation from other types of gestational anemias Objective: The index study was aimed at establishing a new early criterion for the diagnosis of dilutional anemia using maternal total plasma protein levels and maternal hemoglobin concentration estimated using five different types of hemoglobinometers during the trimesters of pregnancy among pregnant women attending the Antenatal clinic at University of Calabar Teaching Hospital (UCTH) Calabar compare to non-pregnant women. Methods: This cross-sectional study involved 400 participants comprising of (n=200 registered pregnant women (50%) and n=200 non-pregnant women (50%) with ages from 18 years and above, who had been previously counseled and had completed an opened-ended, semi-structured self-administered questionnaire form after providing informed / written consent. All blood samples collected by standard methods, were analyzed for total plasma protein levels using Biuret’s spectrophotometric method, while hemoglobin concentration was measured using HemoCue rapid diagnostic test, micro-hematocrit /Packed cell volume (PCV), Copper sulphate (CuSO4) gravimetric method, Tallquist’s hemoglobin scale and Sahli’s method (also called as acid hematin method which is the visual comparator method for the estimation of hemoglobin). Results: The Mean age ± SD (years) for pregnant women  was 24.99±1.01 compared to  non-pregnant women  29.95±7.85 with statistically significant difference between ages (P<0.05, t=7.2822, P=0.0001).The mean value plus one standard deviation (X±SD) of total plasma protein (TPP) levels in g/dl for first, second, third trimesters and total for pregnant women at which dilution anemia occurred  were  6.47 ± 0.88, 5.7± 0.76, 5.6 ± 0.67 and  5.92 ± 0.77 respectively compared to  7.48±.79  for non-pregnant women. The mean value plus one standard deviation of hemoglobin concentration in g/dl per trimester using the five different type of hemoglobinometers at which dilutional anemia occurred were 12.77±.52,11.4 ± 0.23,10.9± 0.89 and 10.98± 0.36 respectively for pregnant women compared to 12.84±1.7 for nonpregnant women. The prevalence of dilutional anemia was significantly higher in  pregnant women (03.5%) compared to non-pregnant women (1.5%). Conclusion: This study highlights the importance of accurate hemoglobin concentration measurement throughout the three trimesters of pregnancy using reliable five different types of point of care testing rapid diagnostic hemoglobinometers. The combined hemoglobin concentration and total plasma protein levels suggests additional potential utility in diagnosing dilutional anemia among pregnant women compared to non-pregnant women.