Comparative Study of Fibrinolytic Response amongst Malarious Pregnant and Non Malarious Subjects in Rivers State, Nigeria

Abstract

Aim: The study was designed to comparatively assess the degree of fibrinolytic response amongst   malaria-positive pregnant women, and non-malaria positive subjects in Rivers State, Nigeria. Methods: The study area covered University of Port Harcourt Teaching Hospital, Port Harcourt [UPTH] and Rivers State University Teaching Hospital, [RSUTH] both in Port Harcourt metropolis Rivers State.  It was a cross-sectional study carried out on a total of two hundred and forty female attendees at the obstetrics and gynecology clinics of the two hospitals. The subjects were grouped into three comprising of eighty subjects in each group; malarious pregnant women, non- malarious pregnant women and apparently healthy non-pregnant women. Venous blood sample measuring 5 milliliter volume was drawn from each subject, The sample was dispensed into two separate EDTA anticoagulant bottles, 3 milliliter and 2 milliliter meant for measuring the levels of markers of fibrinolysis which were Plasminogen, Plasminogen activator inhibitor-1, Plasminogen activator inhibitor-2, Tissue Plasminogen activator, alpha-2-antiplasmin, D-dimers and fibrinogen, and      preparation of blood films for malaria microscopy respectively. Results: Fibrinogen result; 760.44±16.18 ng/ml of malaria-positive pregnant women was elevated compared to the malaria-negative women; 697.70±18.84 ng/ml and the non-pregnant control values of 704.73±15.25 ng/ml. These values were significantly different [P<.011] between the study groups. Results of tissue plasminogen activator [tPA]; 46.39±2.69 ng/ml, D-dimer; 77.64±6.94 ng/ml, plasminogen activator inhibitor-1 [PAI-1]; 89.73±2.14 ng/ml, plasminogen activator inhibitor-2 [PAI-2]; 568.00±12.51 ng/ml, plasminogen; 23.82±0.75 ng/ml and 2-antiplasmin; 1314.06±34.64 ng/ml of the malaria-positive pregnant women were significantly different [P=0.0001] from  non-positive pregnant women; tPA; 28.87±1.38 ng/ml, D-dimer; 53.90±1.18 ng/ml., PAI-1; 80.00± 1.81 ng/ml, PAI-2; 456.31±5.94 ng/ml, Plasminogen; 16.63±0.67 ng/ml and 2-antiplasmin; 1130.61±29.74 ng/ml . Both results were significantly different [P=0.0001] from the non-pregnant control group; tPA; 31.34±1.64 ng/ml, D-dimer; 30.24±1.04 ng/ml, PAI-1; 65,47±2,33 ng/ml, PAI-2; 427.86±6.95 ng/ml, plasminogen; 16.49±0.04 ng/ml and 2-antiplasmin; 1016.98±24.51 ng/ml. Conclusion: The study witnessed significantly high concentrations of fibrinolytic markers in malaria-positive pregnant women. This could be due to compromised endothelial cell function resulting to overproduction of biomarkers of fibrinolysis. The implication is thrombus formation and excessive bleeding in pregnancy which could lead to miscarriages, fetal death or maternal mortality.