Peripheral Hematological Parameters in Sudanese Women with Polycystic Ovary Syndrome

Shaza Mohammed^1*, Enaam T. Elhaj², Mohamed A. Ahmed³, Reem Eltayeb⁴, Ishag Adam³

¹Faculty of Medicine and Health Sciences, Al-Neelain University, Khartoum, Sudan.
²College of Applied Medical Sciences, Shaqra University, Shaqra, Kingdom of Saudi Arabia.
³Department of Obstetrics and Gynecology, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Kingdom of Saudi Arabia.
⁴Department of Medical Laboratory Science, College of Applied Medical Sciences, University of Ha’il, Ha’il, Saudi Arabia.

DOI: 10.4236/crcm.2022.117037                

Abstract

The aim of this study is to assess the association between polycystic ovarian syndrome (PCOS) and hematological parameters [hemoglobin, red cell parameters, white blood cells (WBCs), platelets volume (MPV)]. This is a matched case-control study (60 women in each arm of the study) which was conducted in Saad Abualila infertility center Hospital in Khartoum, Sudan. Infertile women with PCOS were the cases and healthy non pregnant women were the controls. The gynecological characteristics were gathered through questionnaire and blood samples were analyzed for different blood parameters by automated hematology analyzer. While the two groups were matched in their age; body mass index was significantly higher in women with PCOs compared to the normal control. The investigated different hematological parameters (hemoglobin, RBCs, RDW, WBCs, platelets and MPV) showed no statistical difference between the women with PCOS and the controls.

Keywords

Hemoglobin, Platelets Volume, Polycystic Ovarian Syndrome, Red Blood Cells, White Blood Cells

1. Introduction

Polycystic ovary syndrome (PCOS) is essentially a group of endocrine disorders, with a complex of metabolic, endocrinological and genetic factors that commonly affect women during reproductive age [1]. This syndrome is characterized by irregular, anovulatory menstrual cycles, features of hyperandrogenism, and polycystic ovaries. PCOS can lead to poor obstetric outcomes such as infertility, pregnancy loss, gestational diabetes and macrosomia which are affecting 5% - 20% of women with reproductive age [2] [3] [4]. Moreover, PCOS is associated with various changes such as metabolic syndrome, insulin resistance, hypertension, dyslipidemia and increased cardiovascular disease [5] [6].

In spite of the advance in the many disciplines (genetic, environmental and inflammatory biomarker), the exact etiology and pathophysiology of PCOS are not yet fully elucidated [7]. Several recent researches have reported inconsistent association between PCOS and the different components of the hematological parameters [8] - [19]. Thus, association between hematological parameters and PCOs is still an area of active research. Hence there is a need to conduct further research on blood parameters and PCOs. Moreover, the analyses of the peripheral blood parameters were previously performed using manual procedure which was a time consuming and needs personnel with high technical skills and its results might be doubtful. Nowadays the analyses and interpretation of peripheral blood parameters are conducted using automated analyzers. PCOS is the main cause of female infertility in Sudan [20]. Previous studies have shown that different metabolic and hormonal factors were associated with PCOS in Sudan [21] [22]. In Sudan, there are no published data concerning the relation between PCOS and complete blood count (CBC). Thus, the current study was conducted among Sudanese women to describe the relation between PCOS and different hematological parameters Saad Abualila infertility center (Khartoum, Sudan).

2. Methods

This was a case-control study carried out at Saad Abualila infertility center (Khartoum, Sudan) during the period of May to December 2019. Saad Abualila Hospital is a tertiary semi-private hospital governed by the Faculty of Medicine, University of Khartoum. Cases were women with confirmed PCOS based on Rotterdam criteria [3]. Women with systemic disease (cardiovascular disease and diabetes mellitus), on medication for 6 months prior to the study (oral contraceptives, glucocorticoids, ovulation induction agents, and estrogenic or anti-androgenic) were excluded from the cases and controls.

After signing an informed consent the socio-demographic, medical and gynecological history was taken from each patient using questionnaire. The detailed medical and gynecological history was taken (menstrual, fertility, hirsutism, acne, acanthosis nigricance, scalp, hair loss or thinning) were taken from all patients included in the study. Then full general and pelvic examinations were performed.

Body weight (kg), height (cm), was measured in all women and BMI was calculated by dividing the weight (in kg) by the height (m²). Thereafter, two 2 mL of blood was withdrawn (under aseptic condition) from every participant in an ethylene diamine tetra acetic acid by a trained technician. The sample was analyzed for a complete blood count using an automated hematology analyzer guided by the manufacturers’ instructions (Sysmex KX-21, Japan) previously described [23] [24].

A total sample size of 60 women in each arm of the study (cases and controls) was calculated according to the expected difference in the mean of the investigated variables (WBC, hemoglobin, platelets RBCs and RDW) that would provide 80% power to detect a 5% difference at α = 0.05 and assumed that 10% of women would not respond or have incomplete data.

3. Statistics

Data were entered in computer using SPSS for data analyses and expressed as proportions, mean (SD) and median (interquartile). The continuous variables were assessed for normality using Shapiro test. T-test and Mann-Whitney U-test were used to compare the continuous data between the cases and the controls when the data were normally and abnormally distributed, respectively. Χ² test was used to compare the categorical variables. Two-tailed tests were used and P < 0.05 was considered statistically significant.

4. Results

During the study 60 women in each arm of the study were enrolled in the study. There was no significant difference between the cases and the controls in their age, residence and education. The BMI was significantly higher in women with PCOs compared to the normal controls, Table 1.

There was no significant difference in all of the hematological parameters (hemoglobin, RBCs, WBCs, platelets), Table 2.

5. Discussion

The current study showed no significant difference in the various hematological values between the women with PCOs and the controls. In our neighbor Kingdom of Saudi Arabia, recently ALhabardi et al., have shown that the hematological

Table 1. Comparing the socio-demographic characteristics in women with polycystic ovarian syndrome with the controls.

Table 2. Median (interquartile range) of hematological values in women with polycystic ovarian syndrome and the controls.

parameters were not different between women with PCOS and health controls [8]. Moreover, Kałużna et al., have shown that WBC were not different between women with PCOS and controls [9]. Our findings were consistent with Ucakturk et al., findings who observed no significant difference in the homological parameters namely hemoglobin, RBCs, platelets count and WBCs between the women with PCOS and women without PCOS [25]. Likewise, It has been reported previously reported that serum iron levels were not different between women who had PCOs and the controls of women who had no PCOS [26].

A significantly higher of hemoglobin has been reported in women with PCOS compared with the healthy women (control) [27]. This finding (high hemoglobin) has been explained by the hormone levels in PCOS women which might influence on hemoglobin levels through a dose-dependent stimulatory effect on erythropoiesis [28] [29]. Furthermore, androgen receptor in the bone marrow might lead to increase in hemoglobin level [30]. The reduced frequency of menstruation in women with PCOS group is thought to cause the differences of hemoglobin level between PCOS and control groups.

Our results showed no significant difference in the WBCs counts between the women with PCOS compared with women without PCOS. Several previous studies have shown that WBC count was significantly higher in the women with PCOS group [12] [17] [18]. Moreover, a positive predictive effect of WBCs as well as a negative predictive effect of lymphocytes on insulin resistance has been reported in women with PCOS [31]. It is worth to be mentioned that an aerobic exercise might reverse the higher WBCs in women with PCOS [32].

Although, we did not show a significant difference in the MPV, RDW in women with PCOS and controls, previous studies have shown that MPV, NLR, neutrophil count, neutrophil to total leucocyte ratio were significantly higher in women with PCOS compared with the controls [13] [14] [33].

6. Conclusion

The current study showed no significant difference in the hematological parameters in Sudanese women with PCOS and the healthy controls. A study with larger sample size is required in the future to confirm this finding and we did not assess many other hematological variables e.g. serum ferritin as well as other inflammatory markers e.g. C-reactive protein and insulin resistance.

Conflicts of Interest

The authors declare no conflicts of interest regarding the publication of this paper.

References

[1]	ALhabardi, N.A., Al-Wutayd, O., Eltayieb, K.M., Shiha, Y.S., Al-Shafei, A.I. and Adam, I. (2020) Peripheral Hematological Parameters in Women with Polycystic Ovary Syndrome. Journal of International Medical Research, 48, 300060520952282. https://doi.org/10.1177/0300060520952282
[2]	Ntumy, M., Maya, E., Lizneva, D., Adanu, R. and Azziz, R. (2019) The Pressing need for Standardization in Epidemiologic Studies of PCOS across the Globe. Gynecological Endocrinology, 35, 1-3. https://doi.org/10.1080/09513590.2018.1488958
[3]	Bozdag, G., Mumusoglu, S., Zengin, D., Karabulut, E. and Yildiz, B.O. (2016) The Prevalence and Phenotypic Features of Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis. Human Reproduction, 31, 2841-2855. https://doi.org/10.1093/humrep/dew218
[4]	Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group (2004) Revised 2003 Consensus on Diagnostic Criteria and Long-Term Health Risks Related to Polycystic Ovary Syndrome. Fertility and Sterility, 81, 19-25. http://www.ncbi.nlm.nih.gov/pubmed/14711538
[5]	Hallajzadeh, J., Khoramdad, M., Karamzad, N., Almasi-Hashiani, A., Janati, A., Ayubi, E., et al. (2018) Metabolic Syndrome and Its Components among Women with Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis. Journal of Cardiovascular and Thoracic Research, 10, 56-69.
[6]	Tay, C.T., Hart, R.J., Hickey, M., Moran, L.J., Earnest, A., Doherty, D.A., et al. (2020) Updated Adolescent Diagnostic Criteria for Polycystic Ovary Syndrome: Impact on Prevalence and Longitudinal Body Mass Index Trajectories from Birth to Adulthood. BMC Medicine, 18, Article No. 389. https://doi.org/10.1186/s12916-020-01861-x
[7]	Ganie, M., Vasudevan, V., Wani, I., Baba, M., Arif, T. and Rashid, A. (2019) Epidemiology, Pathogenesis, Genetics & Management of Polycystic Ovary Syndrome in India. Indian Journal of Medical Research, 150, 333-344. https://doi.org/10.4103/ijmr.IJMR_1937_17
[8]	Qiu, M.T., Tao, Y., Kuang, Y.P. and Wang, Y. (2019) Effect of Body Mass Index on Pregnancy Outcomes with the Freeze-All Strategy in Women with Polycystic Ovarian Syndrome. Fertility and Sterility, 112, 1172-1179. https://doi.org/10.1016/j.fertnstert.2019.08.009
[9]	Kałużna, M., Człapka-Matyasik, M., Wachowiak-Ochmańska, K., Moczko, J., Kaczmarek, J., et al. (2020) Effect of Central Obesity and Hyperandrogenism on Selected Inflammatory Markers in Patients with PCOS: A WHtR-Matched Case-Control Study. Journal of Clinical Medicine, 9, Article 3024. https://doi.org/10.3390/jcm9093024
[10]	Pergialiotis, V., Trakakis, E., Parthenis, C., Hatziagelaki, E., Chrelias, C., Thomakos, N., et al. (2018) Correlation of Platelet to Lymphocyte and Neutrophil to Lymphocyte Ratio with Hormonal and Metabolic Parameters in Women with PCOS. Hormone Molecular Biology and Clinical Investigation, 34, 20170073. https://doi.org/10.1515/hmbci-2017-0073
[11]	Herlihy, A.C., Kelly, R.E., Hogan, J.L., O’Connor, N., Farah, N. and Turner, M.J. (2011) Polycystic Ovary Syndrome and the Peripheral Blood White Cell Count. Journal of Obstetrics and Gynaecology, 31, 242-244. https://doi.org/10.3109/01443615.2011.553693
[12]	Rudnicka, E., Kunicki, M., Suchta, K., Machura, P., Grymowicz, M. and Smolarczyk, R. (2020) Inflammatory Markers in Women with Polycystic Ovary Syndrome. BioMed Research International, 2020, Article ID: 4092470. https://doi.org/10.1155/2020/4092470
[13]	Yilmaz, Ö., Mehmet, C., Kelekci, S. and Temur, M. (2015) Association between Red Blood Cell Distribution Width and Polycystic Ovary Syndrome. Endocrine Research, 40, 181-187. https://doi.org/10.3109/07435800.2014.987398
[14]	Yilmaz, M.A., Duran, C. and Basaran, M. (2016) The Mean Platelet Volume and Neutrophil to Lymphocyte Ratio in Obese and Lean Patients with Polycystic Ovary Syndrome. Journal of Endocrinological Investigation, 39, 45-53. https://doi.org/10.1007/s40618-015-0335-2
[15]	Keskin Kurt, R., Okyay, A.G., Hakverdi, A.U., Gungoren, A., Dolapcioglu, K.S., Karateke, A., et al. (2014) The Effect of Obesity on Inflammatory Markers in Patients with PCOS: A BMI-Matched Case-Control Study. Archives of Gynecology and Obstetrics, 290, 315-319. https://doi.org/10.1007/s00404-014-3199-3
[16]	Usta, A., Avci, E., Bulbul, C.B., Kadi, H. and Adali, E. (2018) The Monocyte Counts to HDL Cholesterol Ratio in Obese and Lean Patients with Polycystic Ovary Syndrome. Reproductive Biology and Endocrinology, 16, Article No. 34. https://doi.org/10.1186/s12958-018-0351-0
[17]	Papalou, O., Livadas, S., Karachalios, A., Tolia, N., Kokkoris, P., Tripolitakis, K., et al. (2015) White Blood Cells Levels and PCOS: Direct and Indirect Relationship with Obesity and Insulin Resistance, but Not with Hyperandogenemia. Hormones, 14, 91-100. https://doi.org/10.14310/horm.2002.1563
[18]	Shi, Y., Han, T., Cui, L., Wu, G., Zheng, R., Xia, M., et al. (2013) White Blood Cell Differential Counts in Patients with Polycystic Ovary Syndrome: A Pilot Study on Chinese Women. European Journal of Obstetrics & Gynecology and Reproductive Biology, 170, 162-164. https://doi.org/10.1016/j.ejogrb.2013.06.002
[19]	Rashad, N.M., El-Shal, A.S. and Abdelaziz, A.M. (2013) Association between Inflammatory Biomarker Serum Procalcitonin and Obesity in Women with Polycystic Ovary Syndrome. Journal of Reproductive Immunology, 97, 232-239. https://doi.org/10.1016/j.jri.2012.10.007
[20]	Elhussein, O.G., Ahmed, M.A., Suliman, S.O., Yahya, L.I. and Adam, I. (2019) Epidemiology of Infertility and Characteristics of Infertile Couples Requesting Assisted Reproduction in a Low-Resource Setting in Africa, Sudan. Fertility Research and Practice, 5, Article No. 7. https://doi.org/10.1186/s40738-019-0060-1
[21]	Mohammed, S., Awooda, H.A., Rayis, D.A., Hamdan, H.Z., Adam, I. and Lutfi, M.F. (2017) Thyroid Function/Antibodies in Sudanese Women with Polycystic Ovarian Disease. Obstetrics & Gynecology Science, 60, 187-192. https://doi.org/10.5468/ogs.2017.60.2.187
[22]	Abbas, W., Adam, I., Rayis, D.A., Hassan, N.G. and Lutfi, M.F. (2020) Thyroid Hormones Profile among Obese Pregnant Sudanese Women. Journal of Clinical and Translational Research, 6, 14-19.
[23]	Standard Operating Procedure References Applicable to. https://www.gundersenhealth.org/app/files/public/6473/Lab-Policies-Complete-Blood-Count-of-Whole-Blood-on-the-Sysmex-KX-21N---RB-Lab-1535.pdf.
[24]	Rayis, D.A., Ahmed, M.A., Abdel-Moneim, H., Adam, I. and Lutfi, M.F. (2017) Trimester Pattern of Change and Reference Ranges of Hematological Profile among Sudanese Women with Normal Pregnancy. Clinics and Practice, 7, Article No. 888. https://doi.org/10.4081/cp.2017.888
[25]	Ucakturk, A., Demirel, F., Tayfun, M., Tepe, D., Elmaogullari, S. and Kara, O. (2014) Complete Blood Count Parameters in Girls with Polycystic Ovary Syndrome. ESPE Abstracts, 82, P-D-3-3-80. http://abstracts.eurospe.org/hrp/0082/hrp0082p3-d3-804
[26]	Hossein Rashidi, B., Shams, S., Shariat, M., Kazemi Jaliseh, H., Mohebi, M. and Haghollahi, F. (2017) Evaluation of Serum Hepcidin and Iron Levels in Patients with PCOS: A Case-Control Study. Journal of Endocrinological Investigation, 40, 779-784. https://doi.org/10.1007/s40618-017-0632-z
[27]	Han, Y., Kim, H.S., Lee, H.-J., Oh, J.-Y. and Sung, Y.-A. (2015) Metabolic Effects of Polycystic Ovary Syndrome in Adolescents. Annals of Pediatric Endocrinology & Metabolism, 20, 136-142. https://doi.org/10.6065/apem.2015.20.3.136
[28]	Berria, R., Gastaldelli, A., Lucidi, S., Belfort, R., De Filippis, E., Easton, C., et al. (2006) Reduction in Hematocrit Level after Pioglitazone Treatment Is Correlated with Decreased Plasma Free Testosterone Level, Not Hemodilution, in Women with Polycystic Ovary Syndrome. Clinical Pharmacology & Therapeutics, 80, 105-114. https://doi.org/10.1016/j.clpt.2006.03.014
[29]	Coviello, A.D., Kaplan, B., Lakshman, K.M., Chen, T., Singh, A.B. and Bhasin, S. (2008) Effects of Graded Doses of Testosterone on Erythropoiesis in Healthy Young and Older Men. The Journal of Clinical Endocrinology & Metabolism, 93, 914-919. https://doi.org/10.1210/jc.2007-1692
[30]	Claustres, M. and Sultan, C. (1988) Androgen and Erythropoiesis: Evidence for an Androgen Receptor in Erythroblasts from Human Bone Marrow Cultures. Hormone Research in Paediatrics, 29, 17-22. https://doi.org/10.1159/000180959
[31]	Tola, E.N., Yalcin, S.E. and Dugan, N. (2017) The Predictive Effect of Inflammatory Markers and Lipid Accumulation Product Index on Clinical Symptoms Associated with Polycystic Ovary Syndrome in Nonobese Adolescents and Younger Aged Women. European Journal of Obstetrics & Gynecology and Reproductive Biology, 214, 168-172. https://doi.org/10.1016/j.ejogrb.2017.05.014
[32]	Covington, J.D., Tam, C.S., Pasarica, M. and Redman, L.M. (2016) Higher Circulating Leukocytes in Women with PCOS Is Reversed by Aerobic Exercise. Biochimie, 124, 27-33. https://doi.org/10.1016/j.biochi.2014.10.028
[33]	Peker, N., Ege, S., Bademkiran, M.H., Aydin, E., Karacor, T., Obut, M., et al. (2019) Can Clomiphene Citrate Resistance Be Predicted by RDW-CV Levels in Infertile Women with PCOS? Nigerian Journal of Clinical Practice, 22, 1463-1466. https://doi.org/10.4103/njcp.njcp_666_18