RCOG World Congress 2025

DELTA NEUTROPHIL INDEX AND SERUM CALPROTECTIN LEVELS IN INTRAHEPATIC CHOLESTASIS OF PREGNANCY

Intrahepatic Cholestasis of Pregnancy is a condition characterized by pruritus without any associated skin rash along with elevation in the serum bile acid levels ,typically in the late trimesters which resolves after delivery

Adverse Outcomes

•Meconium-stained liquor

•Intrauterine death

•Premature delivery

•Increased risk of Pre-eclampsia

•Gestational Diabetes Mellitus

Currently, Serum Bile acid is the standard diagnostic marker for IHCP

Serum delta neutrophil index (DNI), a new inflammatory marker, reflects the ratio of circulating immature granulocytes related to infection and inflammation to the total number of neutrophils.

•DNI (%) = (the leucocyte subfraction assayed in the MPO channel by cytochemical fraction) – (the leucocyte subfraction assayed using the nuclear lobularity channel by reflected light beam measurements) with a flow cytometry based hematolgic analyzer.

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•For CBC 3ml of blood was collected in the EDTA vial and the sample was processed on the same day along with a peripheral smear examination handed over to us with the heme-analyzer report . DNI values were then calculated from this report using the formula :

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DNI % = (Neutrophil% + Eosinophil% ) – Poly Morpho Nuclear Leucocyte %

Calprotectin (S100 A8 /A9), a Ca++ Binding protein belonging to the S100 family is also known as the 27E10 antigen, is a protein that is expressed on immunocytes & stimulates the production of cytokines & leucocyte production

The Serum Calprotectin were calculated using the Human Calprotectin ELISA© Cat.no E4010Hu , which was a sandwich ELISA kit for the accurate quantitative detection of human Calprotectin (also known as CAL) in serum, plasma, cell culture supernates, cell lysates, tissue homogenates. The kit’s Standard Curve Range was between 2ng/ml - 600ng/ml with a sensitivity of 1.67ng/ml.

To find the association of maternal Delta Neutrophil Index & serum Calprotectin levels with Intrahepatic Cholestasis of Pregnancy.

To find the co-relation between both DNI & Serum Calprotectin levels with bile acids in antenatal women with Intrahepatic Cholestasis of Pregnancy

STUDY DESIGN: Prospective observational study

STUDY DURATION: 18 months

INCLUSION CRITERIA :

Women with singleton pregnancy > 28 weeks of gestation with complaint of itching and elevated Serum liver Transaminases ALT and AST >40 IU/ml.

EXCLUSION CRITERIA :

•Dermatological pathology

•Chronic inflammatory conditions

•Associated comorbidities like Gestational Diabetes Mellitus , Infections, Hypertensive disorders

•Serology positive for Hepatitis A,B,C

Patients on prior medication (ursodeoxycholic acid)

RCOG World Congress 2025

DELTA NEUTROPHIL INDEX AND SERUM CALPROTECTIN LEVELS IN INTRAHEPATIC CHOLESTASIS OF PREGNANCY

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