The use of angiogenic biomarkers to differentiate non-HELLP related thrombocytopenia from HELLP syndrome.
OBJECTIVE
Preeclampsia (PE) is diagnosed using clinical criteria and in atypical cases the diagnosis may be inaccurate as there are no specific tests to confirm or exclude PE. This study sought to evaluate the utility of angiogenic biomarkers, sFlt1, sEng and PlGF to distinguish patients with gestational thrombocytopenia and immune thrombocytopenic purpura (ITP) from patients with thrombocytopenia resulting from the HELLP (hemolysis, elevated liver enzymes and low platelets) syndrome, a complication of severe PE.


METHODS
Serum was collected and the angiogenic biomarkers of patients with ITP and gestational thrombocytopenia (N = 9) were compared to patients with HELLP (N = 11) and PE (N = 11). Circulating levels of these angiogenic biomarkers were also compared by gestational age to 1564 randomly selected normotensive women from the Calcium for Preeclampsia Prevention study.


RESULTS
Patients with non-HELLP thrombocytopenia had lower sFlt1 (7.3 +/- 3.8 ng/ml vs. 15.5 +/- 5 ng/ml, P < 0.001), lower sEng (8.7 +/- 3.6 vs. 34 +/- 17, P < 0.001) and higher PlGF (484 +/- 412 vs. 66.3 +/- 44, P = 0.003) than patients with HELLP syndrome. Angiogenic factor abnormalities in patients with PE were similar to patients with HELLP syndrome, suggesting a common pathogenesis. Patients with non-HELLP thrombocytopenia had angiogenic profiles similar to normotensive controls, whereas patients with HELLP syndrome had levels higher than the 90th percentile for sFlt1 and sEng and lower than the 10th percentile for PlGF.


CONCLUSIONS
Angiogenic biomarkers may be useful in excluding conditions that mimic PE.
Young
Brett
B
Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA.
Levine
Richard J
RJ
Salahuddin
Saira
S
Qian
Cong
C
Lim
Kee-Hak
KH
Karumanchi
S Ananth
SA
Rana
Sarosh
S
D000328:Adult; D015703:Antigens, CD / Q000032:analysis / Q000097:blood; D015415:Biomarkers / Q000032:analysis / Q000097:blood*; D003937:Diagnosis, Differential; D000071063:Endoglin; D005260:Female; D017359:HELLP Syndrome / Q000097:blood / Q000175:diagnosis*; D006801:Humans; D008565:Membrane Proteins / Q000032:analysis / Q000097:blood; D018919:Neovascularization, Physiologic / Q000502:physiology; D010865:Pilot Projects; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000097:blood / Q000175:diagnosis*; D011956:Receptors, Cell Surface / Q000032:analysis / Q000097:blood; D013921:Thrombocytopenia / Q000097:blood / Q000175:diagnosis*; D040281:Vascular Endothelial Growth Factor Receptor-1 / Q000032:analysis / Q000097:blood; D055815:Young Adult
D015703:Antigens, CD; D015415:Biomarkers; C064206:ENG protein, human; D000071063:Endoglin; D008565:Membrane Proteins; C098069:PIGF protein, human; D011956:Receptors, Cell Surface; D040281:Vascular Endothelial Growth Factor Receptor-1
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