Plasma Volume Contraction: A Significant Factor in Both Pregnancy-Associated Hypertension (Pre Eclampsia) and Chronic Hypertension in Pregnancy

The role of plasma volume in hypertension in pregnancy (pre-eclampsla)was investigated. Significant volume expansion from non-pregnantlevels (16·5 ± 1·60 ml/cm height) was presentthroughout pregnancy in 189 normal women, reaching 23·1± 1·21 ml/cm at 33–36 weeks amenorrhoea.In another 40 initially normotensive pregnant women who developedhypertension, simllar early volume expansion was followed bysignificant volume contraction in the third trimester, beforeelevation of blood pressure in 29 (20·6 ± 1·26ml/cm), after it in 11(18·6 ± 1·27 ml/cm).Equivalent volume contraction was present in another 44 womenstudied only after hypertension developed in the third tri mester.Oedema had no value as a clinical sign. In another 30 women with chronic hypertension, blood pressurewas inversely related to plasma volume (r = –0·822)and to fetal growth (r = –0·710), which was directlyrelated to plasma volume (r=0·701). Plasma volume depletionplays a significant role in hypertension in pregnancy.     

Haemoconcentration in severe pre-eclampsia

Summary. The last maternal haemoglobin (Hb) concentration before delivery was related to the perinatal outcome in 87 non-anaemic women suffering from severe pre-eclampsia. Abnormally high Hb concentrations were found in most women with evidence of placental dysfunction. An inverse correlation was found between the centile weight of the newborn and the maternal Hb. Significantly higher Hb levels were found in pregnancies complicated by fetal growth retardation and perinatal distress compared with those in pregnancies with good outcomes. Particularly high levels were found in pregnancies that ended in perinatal deaths. The hypothesis is put forward that raised haemoconcentration during severe pre-eclampsia causes increased maternal blood viscosity which predisposes to placental pathology and initiates a vicious circle.     

Assessment of eosinophil granule proteins in various body fluids: is there a relation to clinical variables in childhood asthma?

BACKGROUND: The eosinophil plays a central role in the inflammatory process in bronchial asthma. Recent studies have indicated that the assessment of eosinophil-derived proteins in various body fluids could be used for monitoring disease activity of childhood asthma. Till now, no study exists which compared the levels of eosinophil-derived proteins in various body fluids such as serum, nasal lavage fluid (NALF) and urine. OBJECTIVE: To investigate whether eosinophil granule proteins in different compartments were correlated and whether there is a relationship between disease activity, pulmonary function and bronchial hyperreactivity. METHODS: Twenty-eight children with atopic bronchial asthma were recruited. Serum, NALF and urine samples were obtained and assessed for eosinophil cationic protein (ECP) and eosinophil protein X (EPX). The levels of eosinophil proteins were analysed for a relationship with lung function variables, bronchial hyperreactivity and disease activity. Eleven healthy control subjects were used as controls. RESULTS: Median ECP and EPX concentrations in serum (31.4 and 74.8 microg/L vs 15.8 and 24.3 microg/L, respectively), NALF (9.9 and 44. 9 microg/L vs 0 and 2.5 microg/L, respectively) and urine (49.4 vs 16.5 microg/mmol creatinine) were significantly raised in children with bronchial asthma compared with healthy control subjects. In addition, ECP and EPX levels in serum and urine samples were significantly higher in symptomatic patients compared with asymptomatic subjects with asthma. Although no relationship between eosinophil-derived proteins in serum, NALF or urine and the level of nonspecific bronchial hyperreactivity could be detected, the concentrations of EPX in serum and urine were correlated with variables of pulmonary function. CONCLUSION: Our findings demonstrate increased eosinophil activity in serum, NALF and urine derived from children with bronchial asthma. Due to the relationship between levels of eosinophil proteins in serum/urine samples and lung function, as well as significant concentration differences between symptomatic and asymptomatic asthmatic children, the assessment of eosinophil proteins in serum or urine samples appear to be more appropriate in monitoring disease activity than measurement of ECP or EPX in NALF. Thus, the determination of serum ECP/EPX or urinary EPX may be preferentially used in monitoring eosinophilic inflammation in childhood asthma.