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LABORATORY TESTS TO HELP DIAGNOSE CROHN'S DISEASE IN PREGNANCY

S Rawal, A Bitton, I Shrier, M Martin, M Al- Madi, E MacNamara, A Szilagyi
SMBD Jewish General, Royal Victoria hospitals, McGill University, Montreal, Quebec

BACKGROUND: The peak age of Crohn's disease (CD) coincides with reproductive age. Invasive tests are discouraged in pregnancy, thus diagnostic blood tests are useful for CD. Limited information exists on normal reference ranges in each trimester (TM).
PARTICIPANTS: Healthy pregnant(P) women at a university clinic and CD patients at 2 university clinics are included.
METHODS: Each subject filled a questionnaire (P and CD specific as per case). CD activity was based on Harvey-Bradshaw index (HBI), bloods were drawn for CBC, ESR and CPR. Reference ranges were age and sex specific. Statisitical analyses of results comparing CD and TMs used ANOVA and the ad hoc Dunnet's test.
RESULTS: 100 subjects are included: 64P (11TM1,24TM2,29TM3), 36 CD (15M, 11HBI<=4,25HBI>4). Mean(ąsd) are tabulated for 5 variables. MPV: mean platelet volume, Lym: lymphocytes, PMNL: polymorphonuclear leukocytes, CRP: C-reactive protein. ESR sedimentation rate.

TM1 TM2 TM3 CD
MPVf/L 10.7(0.9) 11.3(0.9) 11.2(1.1) 9.03(2.1)*
Lymx10⁹ 1.9(0.6) 2.01(0.6) 1.7(0.4) 1.5(.0.9)^§
PMNLx10⁹ 6.1(1.05) 6.9(2.1) 6.8(1.7) 1.5(0.9)
CRPmg/L 3.7(3.0) 6.6(6.3) 4.6(3.2) 30.4(51.5)**
ESRmm/H 17.6(7.2) 38.5(16.9) 53.6(20.5) 41.9(22.1)+
*P<0.0001 against any TM,§ P<0.02 against TM2, ** P,0.004 against any TM, + P<0.001 against TM1. CRP was elevated in 63.9% in CD patients and 10.9% in P, mostly TM2.

CONCLUSIONS: High CRP and low MPV are confirmed as characteristic of CD. ESR is high normal in TM1 but increases steadily through TM2 and TM3. In TM1, an abnormally elevated ESR is abnormal and may be used to support CD especially in conjunction with an elevated CRP. CRP remains normal throughout pregnancy. At any TM, a combination of elevated CRP and a low MPV in the appropriate clinical context supports a diagnosis of CD. The validity of these conclusions need to be further asessed in pregnant women with known CD.

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	TM1	TM2	TM3	CD
MPVf/L	10.7(0.9)	11.3(0.9)	11.2(1.1)	9.03(2.1)*
Lymx10⁹	1.9(0.6)	2.01(0.6)	1.7(0.4)	1.5(.0.9)^§
PMNLx10⁹	6.1(1.05)	6.9(2.1)	6.8(1.7)	1.5(0.9)
CRPmg/L	3.7(3.0)	6.6(6.3)	4.6(3.2)	30.4(51.5)**
ESRmm/H	17.6(7.2)	38.5(16.9)	53.6(20.5)	41.9(22.1)+
P<0.0001 against any TM,§ P<0.02 against TM2, * P,0.004 against any TM, + P<0.001 against TM1. CRP was elevated in 63.9% in CD patients and 10.9% in P, mostly TM2.