Ultrstructural and flow cytometric analysis of platelets and fibrin networks during the menstrual cycle and pregnancy

Abstract

INTRODUCTION: The menstrual cycle and pregnancy are processes unique to women. Both these processes involve various hormones as well as the coagulation system. Throughout normal pregnancy, platelet activation and increase in blood coagulation factors contributes to the hypercoagulable state observed on a physiological level. METHODS: Fibrin networks and platelets were analysed by electron microscopy and flow cytometry to determine any differences found in different phases of pregnancy compared to healthy control individuals. The fibrin networks from different phases of the menstrual cycle as well as different phases of pregnancy were investigated. RESULTS: It was found that ultrastructural changes in fibrin fiber morphology result from estrogen changes during the menstrual cycle. During pregnancy the minor thin fibers were prominent and thick matted layers of coagulant formation were evident. A large quantity of protein globular clusters similar to those seen in the menstrual cycle was present. Changes observed in platelet ultrastructure during pregnancy showed pregnancy-specific modifications. Platelets were activated and internal organelles showed variation from control participants. Flow cytometric analysis of platelets verified pregnancy-specific modifications. Close interactions between platelets and erythrocytes were evident. CONCLUSION: The female body is equipped to handle alterations in the coagulation system as can be extrapolated from the pregnancy-specific modifications. This study is the first to show alterations in fibrin network and platelet ultrastructure during and after pregnancy when compared to non-pregnant controls. The physiological changes during normal pregnancy can be used as a standard for comparison to abnormal or ailing pregnancy.