Microcytic Transformation and Erythropoietic Failure in Helicobacter pylori Infected Pregnant Women with Faecal Occult Blood in Abakaliki, Nigeria

Abstract

Microcytic transformation and erythropoietic failure in pregnancy are commonly attributed to iron deficiency and physiological haemodilution; however, the independent and combined contributions of chronic H. pylori infection and occult gastrointestinal blood loss to anaemia severity remain poorly characterised, particularly in Nigerian obstetric populations. This comparative cross-sectional study enrolled 100 pregnant women in four groups: 40 healthy pregnant women (HPW) and 20 women each who were H. pylori-positive (H. P+), faecal occult blood (FOB)-positive (FOB+), or positive for both. Haemoglobin, packed cell volume, and red-cell indices - mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC), and mean corpuscular volume (MCV) - were measured and stratified by trimester and infection status. One-way analysis of variance with Tukey's HSD post hoc test assessed intergroup and trimester differences, while Pearson's correlation assessed associations with fibrinogen. Anaemia severity increased progressively across groups, from a mean haemoglobin of 12.07 ± 1.58 g/dL in HPW to 9.03 ± 2.01 g/dL in the co-positive group (p < 0.0001), and packed cell volume followed the same pattern (36.20 ± 4.05% to 28.21 ± 5.14%; p < 0.0001). The co-positive group was significantly more anaemic than either single-positive group (all pairwise p < 0.05) and showed the most marked microcytic, hypochromic pattern (MCV, 78.22 ± 2.33 fL; MCH, 24.67 ± 1.30 pg; MCHC, 30.89 ± 0.89 g/dL; all p < 0.0001 vs HPW). Trimester analysis showed distinct patterns: women in the H. P+ group had a marked MCV decline (88.00 to 79.00 fL; p = 0.001) by the second trimester, whereas the FOB+ group retained normocytosis until the third trimester (84.00 to 78.33 fL). MCHC declined significantly across trimesters in the H. P+ and co-positive groups, but not in the FOB+ group. These findings indicate that H. pylori infection was associated with an earlier, progressive microcytic hypochromic anaemic pattern, whereas isolated FOB positivity was associated with a later, milder iron-deficient pattern.