Characterization of Placental Pathology in Sickle Cell Disease and Sickle Cell Trait Patients
AS Godambe, Y Li, AM Szpaderska, A Salhadar, CH Ersahin. Loyola University Medical Center, Maywood, IL
Background: The homozygous form of sickle cell disease (SCD) occurs in 1 out of 400 African Americans. Additionally 8% of African Americans have sickle cell trait (SCT), underscoring its prevalence in our society. It is thought that most of the alterations in sickle cell patients' placentas are caused by sickling of erythrocytes, leading to regional hypoxia. Comparing the fetal membranes, the umbilical cord, and the placental disk with normal placentas and correlating their relationship to pregnancy outcome will help our understanding of the importance of changes that occur in these groups of patients.
Design: Archival formalin-fixed paraffin-embedded placental tissues from SCD (n=6), SCT (n=24) and healthy (n=30) in-house patients between 2004 and present were reviewed. In addition, clinical information for each patient and the newborn was obtained to evaluate clinical, hematological, and obstetrical information.
Results: Sickled erythrocytes were seen in 100% of placentas from SCD patients, and in 90% of placentas from SCT patients vs. no sickled erythrocytes seen in normal placentas. (p<0.0001, Chi Square).
Table-1: Placental findings
|Weeks gestation||Placental weight (g)||Fetal weight (g)||Cord length (cm)||% with villitis of unknown etiology||% with meconium staining||% with advanced villous maturation|
Table-2: Maternal and fetal factors
|Age||% with DM||Average APGAR at 1 and 10 min||% C-section||Maternal RBC||Maternal Hgb||Bleeding (mL)|
Conclusions: When evaluating the placenta in a mother with either SCD or SCT, the pathologist should pay close attention to the presence of sickled cells in the intervillous space, advanced villous maturation, villitis of unknown etiology, and meconium staining of the placenta. Each of these histological and morphological features is associated with increased stress to the fetus, and therefore should be correlated with fetal parameters and general fetal well being. Future studies are needed to understand the long term effects of these findings in newborns. The pathologist may be helpful to raise the possibility of sickle cell trait in a previously undiagnosed female by careful observation of erythrocyte morphology in intervillous space.
Monday, March 9, 2009 1:00 PM
Poster Session II # 207, Monday Afternoon