妊娠期女性血液生理变化
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摘要
妊娠期是女性特殊的生理阶段,随着胎儿的生长发育,为了适应胎儿和胎盘的整体需要,妊娠期女性体内会发生一系列的生理性变化,这些变化会影响母体的造血功能,从而引起血液中某些成分发生改变。血浆容积在妊娠的6～12周时会增加10%～15%,然后血容量迅速扩张,直到妊娠的30～34周,此后仅会轻度增加。红细胞总量在妊娠8～10周开始增加,到妊娠末期红细胞容量稳定增加,比非妊娠女性可高出20%～30%。健康妊娠女性的血红蛋白水平会出现轻度下降。中性粒细胞计数在妊娠的第2个月开始增多,到中期妊娠或晚期妊娠时进入平台期,此时总白细胞计数的范围为(9～15)×10~9/L。相比于非妊娠个体,妊娠女性会处于相对高凝状态,原因是某些凝血因子的显著增加、纤维蛋白溶解减少和血小板活性增加。大多数健康妊娠女性的血小板计数仍然保持在未妊娠时的正常范围之内,但是妊娠女性平均血小板计数与健康非妊娠女性相比可能会有轻度降低。了解妊娠期女性血液生理性变化,有助于产科医生进行鉴别诊断及正确处理。
Pregnancy is a special physiological stage of women. With the growth and development of the fetus,in order to meet the overall needs of the fetus and placenta,a series of physiological changes will occur in the body of pregnant women. These changes will affect the maternal hematopoietic function,thus causing changes in some components of the blood. The plasma volume increases by 10% to 15% at 6～12 weeks of gestation,and then rapidly expands until 30～34 weeks of gestation,with only a slight increase thereafter. Total erythrocyte volume began to increase at 8～10 weeks of gestation,and increased steadily at the end of gestation,which was 20%～30%higher than that of non-pregnant women. The level of hemoglobin in healthy pregnant women decreases slightly.The neutrophil count began to increase in the second month of pregnancy,and entered the plateau stage in the second or third trimester of pregnancy. The total white blood cell count ranged from(9～15) ×10~9/L. Compared with non-pregnant individuals,pregnant women are in a relatively high coagulation state due to the significant increase of some coagulation factors,the decrease of fibrinolysis and the increase of platelet activity. The platelet count of most healthy pregnant women is still within the normal range of non-pregnant women,but the average platelet count of pregnant women may be slightly lower than that of healthy non-pregnant women. Understanding the physiological changes of blood in pregnant women is helpful for obstetricians to make differential diagnosis and correct treatment.
Pregnancy is a special physiological stage of women. With the growth and development of the fetus,in order to meet the overall needs of the fetus and placenta,a series of physiological changes will occur in the body of pregnant women. These changes will affect the maternal hematopoietic function,thus causing changes in some components of the blood. The plasma volume increases by 10% to 15% at 6～12 weeks of gestation,and then rapidly expands until 30～34 weeks of gestation,with only a slight increase thereafter. Total erythrocyte volume began to increase at 8～10 weeks of gestation,and increased steadily at the end of gestation,which was 20%～30%higher than that of non-pregnant women. The level of hemoglobin in healthy pregnant women decreases slightly.The neutrophil count began to increase in the second month of pregnancy,and entered the plateau stage in the second or third trimester of pregnancy. The total white blood cell count ranged from(9～15) ×10~9/L. Compared with non-pregnant individuals,pregnant women are in a relatively high coagulation state due to the significant increase of some coagulation factors,the decrease of fibrinolysis and the increase of platelet activity. The platelet count of most healthy pregnant women is still within the normal range of non-pregnant women,but the average platelet count of pregnant women may be slightly lower than that of healthy non-pregnant women. Understanding the physiological changes of blood in pregnant women is helpful for obstetricians to make differential diagnosis and correct treatment.
引文
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[8]Fogerty AE.Thrombocytopenia in pregnancy:mechanisms and management.Transfus Med Rev.2018,32(4):225-229.
[2]McDonagh MS,Blazina I,Dana T,Cantor A,Bougatsos C.Screening and routine supplementation for iron deficiency anemia:a systematic review.Pediatrics,2015,135(4):723-733.
[3]American College of Obstetricians and Gynecologists.ACOGPractice Bulletin No.95:anemia in pregnancy.Obstet Gynecol,2008,112(1):201-207.
[4]Carles G,Tobal N,Raynal P,et al.Doppler assessment of the fetal cerebral hemodynamic response to moderate or severe maternal anemia.Am J Obstet Gynecol,2003,188(3):794-9.
[5]Sifakis S,Pharmakides G.Anemia in pregnancy.Ann N YAcad Sci.2000,900(4):125-136.
[6]Fernández SA,Pascual VT,Gimenez MT,Hernández JF.Immature granulocyte detection by the SE-9000 haematology analyser during pregnancy.Clin Lab Haematol.2003,25(6):347-351.
[7]Pramanik SS,Pramanik T,Mondal SC,Chanda R.Number,maturity and phagocytic activity of neutrophils in the three trimesters of pregnancy.East Mediterr Health J,2007,13(4):862-867.
[8]Fogerty AE.Thrombocytopenia in pregnancy:mechanisms and management.Transfus Med Rev.2018,32(4):225-229.