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Platelet Activation, Sympathetic Tone, and Plasma Volume in Nulligravid Women of Reproductive Age

Dana P. Damron, md^*, Beth A. Bouchard, PhD, Robert E. Shapiro, md, PhD, Adrienne L. Schonberg, rn^* and Ira M. Bernstein, md^*

From the Departments of *Obstetrics and Gynecology, Biochemistry, and Neurology, University of Vermont College of Medicine, Burlington, Vermont.

OBJECTIVE: Preeclampsia is associated with increased platelet activation, increased sympathetic activity, and decreased plasma volume. We sought to estimate the relationship of plasma volume, sympathetic activity, or both to platelet activation in nonpregnant nulligravid women.

METHODS: We studied 37 healthy nulligravid subjects during the follicular phase of the menstrual cycle. After intravenous access was obtained, subjects rested in the supine position for 15 minutes. Blood was drawn without venous constriction for measurement of plasma catecholamines (epinephrine and norepinephrine) and complete blood count. Antigenic markers of platelet activation, CD63 and CD61-CD14 (platelet-monocyte aggregates), were measured with flow cytometry. Plasma volume was estimated in the supine position by using Evans blue dye and is expressed in milliliters and corrected for body mass index (BMI). We compared data from the lowest plasma volume/BMI quartile with the 2 middle quartiles combined and with the upper quartile. Data are expressed as mean ± standard deviation. P < .05 was considered significant.

RESULTS: Subjects were aged 26.5 ± 5.0 years, BMI was 24.0 ± 3.0 kg/m², and plasma volume was 2,685 ± 429 mL. We identified no significant relationship of platelet concentration to plasma volume/BMI between quartile groups (P = .944). However, there was a significant difference between quartiles for %CD63 expression (P = .013) and for CD61/CD14 expression (P = .018), with the lowest quartile demonstrating elevated platelet activation.

CONCLUSIONS: We found evidence that enhanced platelet activation is associated with reduced plasma volume, but not with plasma catecholamine concentrations. There was no association of platelet concentration with reduced plasma volume. We speculate that elements of the clinical syndrome of preeclampsia coexist as a subclinical phenotype before pregnancy.

LEVEL OF EVIDENCE: II-3