Características clínicas e laboratoriais da crise de dor em gestantes com doença falciforme

Abstract

INTRODUCTION: Pregnancy is a high risk condition for women with sickle cell disease and is associated with an increased risk of maternal and fetal morbidity and mortality. Increased frequency and severity of pain crises occur during pregnancy in women with sickle cell disease. OBJECTIVE: The objective of this study was to analyze the clinical and laboratory characteristics of pregnant women with sickle cell disease in the presence of pain crisis. MATERIALS AND METHODS: A prospective, descriptive, exploratory, quantitative-qualitative, observational longitudinal study. Twenty-seven women with sickle cell disease were included in the study, 13 nulliparous and 14 pregnant women, accompanied by the Ambulatório Municipal Especializado em Doença Falciforme and the Ambulatório da Maternidade de Referência Professor José Maria de Magalhães Netto, respectively. We performed structured interview and follow-up of laboratory tests. Statistical analyzes were performed using the software Graph Pad Prism version 6, SPSS version 22, and program Excel version 2010. RESULTS: Most nulliparous and pregnant women classified the pain crisis as frequent. Regarding the duration of pain, most of the nulliparous women took more days to resolve their pain when compared to the pregnant women. Regarding the intensity of pain, there was variation between mild to moderate pain in the two groups, with emphasis on moderate pain in the nulliparous group; and moderate and intense pain in the pregnant group. The most affected anatomic sites were the upper and lower limbs in nulliparous women; and lower limbs and lumbar spine in the group of pregnant women. It is noteworthy that the sensorial and affective factors presented a greater influence on the perception of pain by the participants of this study. The resuls of the laboratory tests analyzed in this study, showed that pregnant women in pain crisis presented significantly lower levels of red blood cells, hematocrit and hemoglobin; significantly higher CHGM value; leukocyte count, percentage of neutrophils, bands and segmented cells were significantly higher; percentage of eosinophils and lymphocytes were significantly lower when compared to nulliparous women with stable disease. CONCLUSIONS: The pain episodes presented by pregnant women with sickle cell disese are associated with altered hematological and hemolytic parameters. Thus, future preventive interventions can be directed to the control of the pain crisis and the blood levels of these parameters in these patients. The results of this work consolidate the idea that pregnancy is a phenomenon associated with pain crisis in sickle cell disease and is able to induce alterations in some laboratory parameters, which should be evaluated to ensure adequate health care, with the purpose of avoiding complications and providing the well- being of pregnant women with sickle cell disease.