RESEARCH PAPER
Assessment of hematological parameters of
neonatal cord blood in anemic and non-anemic
mothers
Mahmoud Mohamed Elgari, Hisham Ali Waggiallah
Department of Medical Laboratory, Faculty of Medical Applied Science, Taibah University, Almadenah Almonawarah,
Saudia Arabia
Correspondence address: Dr. Hisham Ali Waggiallah, Department of Medical Laboratory, Faculty of Medical Applied
Science, Taibah University. P.O. Box 3001, Almadenah Almonawarah, Saudia Arabia. E-mail: [email protected]
DOI: 10.5455/jcer.201321
____________________________________________________________________________________________________
ABSTRACT
Anemia during pregnancy is associated with high rate of mortality and morbidity among mothers and neonates. The
aim of this study was to evaluate hematological parameters of cord blood of neonates born to anemic and non-anemic
mothers. This is a cross-sectional comparative study which was carried out in Khartoum state maternity hospitals, 208
anemic pregnant women of hemoglobin levels less than 11.0gm/dl and 292 non anemic pregnant women of
hemoglobin levels above 11.0gm/dl were enrolled. Cord blood samples were collected from umbilical cord and
drained into K2EDTA containers to estimate complete blood counts using hematological analyzer Sysmex 21,
manual reticulocytes count was performed, and venous K2EDTA blood samples were collected from each mother to
estimate hemoglobin level. Obtained data were compared by SPSS program version 11.5 using student t-test, and
significant level considered as ≤ 0.05. The study revealed that high significant levels of reticulocyte counts (P ≤ 0.05)
in cord blood of neonates born to anemic mothers when compared to non-anemic. In other parameters no significant
result was recognized. We conclude that anemia during pregnancy has significant effect on reticulocyte counts in
neonates been born to anemic mothers in comparison with those were born to non-anemic.
Key words: Anemia, hematological parameter, neonates, pregnancy, umbilical cord
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INTRODUCTION
The umbilical cord is a narrow tube-like structure
that connects the fetus to the placenta. [1] Umbilical
cord consists of one vein, which carries oxygenated,
nutrient-rich blood to the fetus and two arteries that
carry deoxygenated, nutrient depleted blood away
from fetus blood circulation.[2] Although umbilical
vein carries blood towards the fetus's heart, while the
umbilical arteries carry blood away.[3] Hematology
of newborn recently represented as area of study that
focusing in study of umbilical cord blood and its
elements in general.[4] Umbilical cord blood count at
birth shows that there is an increased in hemoglobin,
hematocrit, mean corpuscular volume, leukocyte
count, reticulocyte count and nucleated red blood
cells with presence of occasional immature white
blood cells or left-shifted in peripheral blood of
healthy infants, with variable degree in immature
sick newborns.[5] The mean cord hemoglobin value
varies approximately between 16.6 and 17.1 gm/dl
of blood.[6] The average hematocrit level
approximately 0.55 L/L (55%) at birth.[7] The total
white blood cell count at birth generally high in
ranges between 9 and 30 x 109 / liter.[8] Reticulocyte
number at birth about 4% to 6% and reflected the
activity of the red cell formation in fetal life.[9]
Variable number of platelets during neonatal period
was reported; figure reported at time of birth ranges
from 150 x 109/liter to 350 x 109/liter.[10] Intrauterine
fetus is maternal dependent from embryonic stage,
fetal hood up to birth; hence anemia during
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Elgari and Waggiallah: Hematological parameters in neonatal cord
pregnancy play a major role in causes of fatal life
threatening to the mother and her fetus, and
considered to make serious complications resulting
from lower oxygen delivery, elevation of
erythropoietin level, reticulocyte counts, and
nucleated red blood cells of valuable inspections of
neonatal healthy status.[11] Hence Increased
erythropoietin level of cord blood at time of birth
used as indicator markers for fetal hypoxia.[12]
This is a cross-sectional comparative study which is
carried out in Khartoum state maternity hospitals.
The major purpose of this study was to evaluate
neonatal cord blood hematological values of
newborns in anemic and non-anemic pregnant
women.
MATERIALS AND METHODS
Ethical clearance was obtained from the Ethical
Committee Board of hospital. The verbal consent
was taken from study subjects on explanation of
study objectives. Cross sectional and comparative
study was carried out in departments of Obstetrics
and Gynecology at Khartoum state maternity
hospital, in period July 2011 to June 2013; in all
cases the placental cord was clamped immediately
after delivery, syringe inserted in umbilical vein, and
blood samples were drained containers with
K2EDTA anticoagulant, maternal venous K2EDTA
blood samples were collected. The following
hematimetric variables were performed: Hemoglobin
(Hb), hematocrit (Hct), mean corpuscular volume
(MCV), mean corpuscular hemoglobin (MCH) and
mean corpuscular hemoglobin concentration
(MCHC) were determined using hematological
automated counter (Sysmex 21). Reticulocyte count
(RC) was manually performed using cresyl-blue
stained blood smears, corrected reticulocyte count
(CRC) and reticulocyte production index (RPI) were
calculated.
208 anemic pregnant women of
hemoglobin levels less than 11.0gm/dl and 292 non
anemic pregnant women of hemoglobin levels above
11.0gm/dl were enrolled.
Statistical analysis
Data were compared by SPSS program version 11.5
using student’s t-test, and statistically significant
level considered was ≤ 0.05.
RESULTS
No significant differences in Hb, Hct. MCV, MCH
and MCHC, between data obtained by neonates born
to anemic and non-anemic pregnant women were
found [Table 1].
No significant changes occur in platelet and WBC
counts between two groups, in contrast significant
increases in RC, CRC, and RPI in babies born to
anemic mothers compared to those born to nonanemic mothers (P-value ≤ 0.05) [Table 2].
Table 1: Hematologic values in umbilical cord blood obtained from babies born to anemic (n=292) and
non-anemic (n=208) mothers
Parameter
Hemoglobin (g/L)
Hematocrit (L/L)
Mean Corpuscular Volume (fl)
Mean Corpuscular Hemoglobin (pg)
Mean Corpuscular Hemoglobin Concentration (g/L)
Sample
Mean ± SD
Non anemic
144.5 ± 15.5
Anemic
143.4 ± 14.6
Non anemic
0.44 ± 5.10
Anemic
0.44 ± 5.14
Non anemic
105.5 ± 5.14
Anemic
105.3 ± 5.12
Non anemic
33.5 ±1.99
Anemic
33.2 ±1.96
Non anemic
331 ±11.9
Anemic
332 ±11.4
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P-value
0.8
0.4
0.3
0.5
0.2
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Elgari and Waggiallah: Hematological parameters in neonatal cord
Table 2: Platelet, leukocyte and reticluocytes values in umbilical cord obtained from babies born to
anemic (n=292) and non anemic (n=208)
Parameter
Platelet x 109/L
White Blood Cells x 109/L
Retculocyte Count (%)
Corrected Reticulocyte Count
Reticulocyte Production Index
Sample
Mean ± SD
Non anemic
251 x 109/L ± 92
Anemic
257 x 109/L ± 91
Non anemic
12.5x 109/L ± 8
Anemic
12 x 109/L ± 4
Non anemic
5.5 ± 0.86
Anemic
6.3 ± 1.41
Non anemic
5.4 ± 0.89
Anemic
6.2 ± 1.45
Non anemic
5.2 ± 1.19
Anemic
5.9 ± 1.7
P-value
0.1
0.2
0.05*
0.03*
0.05*
*P ≤ 0.05 using student’s t-test (significant level)
DISCUSSION
The umbilical cord blood hemoglobin is an
important hematological parameter in newborns at
birth. Hemoglobin (Hb) and hematocrit (Hct) values
have been used frequently in the diagnosis and
follow-up of the neonatal anemia.[13] Other
hematological parameters, e.g., white blood cell
count and platelet count are also helpful in the
assessment of neonatal sepsis and haemostatic status
of infant. [14] The haematological values of newborns
depend on several factors, including ethnic group,
maternal health, nutritional status and antenatal
complications such as anemia. [15]
Our results show no variation in mean values for
hemoglobin, hematocrit, and red cell indices related
to status of maternal anemia, indicated follow up of
adequate medical care, hence no significant variation
calculated in compared results between babies born
to anemic and non-anemic mothers, also we
observed no significant differences in mean values
of total leukocyte count and platelet count were
encountered; the findings was in consistency with
study reported in Bangladesh by Elias, et al 2003.[16]
We found significant increases in reticulocyte
count, corrected reticulocyte count, and reticulocyte
production index of cord blood obtained from
newborns of anemic mothers in compared with
those born to non-anemic mothers in agreement
with study on reticulocyte counts done
in
Argentina.[17] Elevated reticulocyte production index
indication for hyper erythropoiesis state of
intrauterine period, the finding is in agreement with
study reported that; reticulocyte fractions in cord
blood obtained from babies born to normal pregnant
women were different in comparison to count from
those obtained from pregnant women complicated
by anemia.
Increases of reticulocyte counts
suggestive of compensatory elevation due to
reduction in oxygen delivery to fetus, the finding is
consistent with previous study to establish
reticulocyte maturation profile in cord blood during
normal pregnancy and pregnancy complicated by
chronic intrauterine hypoxia in which reticulocyte
counts were elevated.[18]
CONCLUSION
We observed no significant changes were
encountered in hemoglobin, hematocrit, red cell
indices, platelet count, white blood cell count of cord
blood of newborns born to anemic or non-anemic
mothers, in contrast significant increased
reticulocyte counts of cord blood of neonates born to
anemic mothers indicated for hyper erythropoiesis
state of intrauterine period particularly during
pregnancy complicated by severe anemia.
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Elgari and Waggiallah: Hematological parameters in neonatal cord
ACKNOWLEDGEMENTS
We are thankful to Professor Babiker Ahmed
Mohamed and staff of clinical hematology
laboratory of Khartoum technical hospital for their
technical assistance in samples collection.
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Cite this article as: Elgari MM, Waggiallah HA. Assessment of
hematological parameters of neonatal cord blood in anemic and
non-anemic mothers. J Clin Exp Res 2013;1:22-25.
Source of Support: Nil, Conflicts of Interest: None declared
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