There is a significant association between elevated tricuspid regurgitation velocity (TRV) and adverse hematologic events in pregnant women with sickle cell disease, a new study published in the British Journal of Haematology found.

Moreover, even though women with sickle cell disease have a higher incidence of venous thromboembolism during pregnancy, this is the first study to show that only those with elevated TRV had venous thromboembolism during pregnancy.

“It is possible women with [elevated TRV] have unrecognized pulmonary vascular thromboembolic disease, which is exacerbated during pregnancy,” the researchers hypothesized. “Alternatively, [elevated TRV] may be a marker for patients with more severe [sickle cell disease], with a higher propensity for adverse hematologic events, including [venous thromboembolism]”.

According to the authors, more research is now needed to evaluate the association between TRV and adverse events such as venous thromboembolism in women with sickle cell disease who are pregnant

Read more about sickle cell disease comorbidities

There is little information about pregnancy outcomes in women with sickle cell disease and elevated TRV. Here, a team of researchers led by Saurabh Rajpal, MBBS, from the Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University & Nationwide Children’s Hospital in Columbus conducted a retrospective cohort study of pregnant women with sickle cell disease and elevated TRV. 

The researchers evaluated adverse hematologic, cardiac, obstetric, and fetal/neonatal events in pregnancy and up to 42 days after birth.

They found that adverse hematologic events such as deep vein thrombosis, pulmonary embolism, and catheter-related thrombosis were more common in pregnant women with elevated TRV compared to those with normal TRV. 

Tricuspid regurgitation is a disorder in which the tricuspid valve, which separates the right ventricle from the right atrium, does not close properly, causing blood to flow backward into the right atrium when the right ventricle contracts. A TRV of at least 2.5 m/s is a marker for underlying pulmonary hypertension in patients with sickle cell disease.

Reference 

Marshall WH 5th, Cleary EM, Della-Moretta S, et al. Elevated tricuspid regurgitation velocity is associated with increased adverse haematologic events during pregnancy in women with sickle cell disease. Br J Haematol. Published online March 24, 2022. doi:10.1111/bjh.18160