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WILLIAM'S HEMATOLOGY > 7 Hematology During Pregnancy > Flashcards

7 Hematology During Pregnancy Flashcards

1
Q

Maternal blood volume increases by an average of _______above the nonpregnant level.

A

40% to 50%

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2
Q

Plasma volume begins to rise early in pregnancy, with most of the escalation taking place in the second trimester and prior to week ______ of gestation.

A

week 32 of gestation

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3
Q

Erythropoietin levels increase throughout pregnancy, reaching approximately _____% of their prepregnancy levels at term

A

150%

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4
Q

The overall effect of these changes in most women is a slight ________ in hemoglobin concentration, which is most pronounced at the end of the ____________ trimester and slowly improves approaching term.

A

Slight drop in hemoglobin concentration

Second trimester

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5
Q

TRUE OR FALSE

In general, white cell counts drop during pregnancy with the occasional appearance of myelocytes or metamyelocytes in the blood.

A

FALSE

In general, white cell counts rise during pregnancy with the occasional appearance of myelocytes or metamyelocytes in the blood.

During labor and the early puerperium, there is a rise in the leukocyte count.

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6
Q

INCREASE, SAME OR DECREASE

C-reactive protein concentration:

Erythrocyte sedimentation rate (ESR):

Von Willebrand factor (VWF), fibrinogen, and factors VII, VIII, and X :

Factors II, V, IX, XI, and XII:

Factor XIII:

Levels of protein C and antithrombin:

Total and free protein S:

Plasminogen activator inhibitor type I and type II:

A

C-reactive protein concentration: INCREASE

Erythrocyte sedimentation rate (ESR): INCREASE

Von Willebrand factor (VWF), fibrinogen, and factors VII, VIII, and X : INCREASE

Factors II, V, IX, XI, and XII: SAME

Factor XIII:DECREASE

Levels of protein C and antithrombin: SAME

Total and free protein S: INCREASE

Plasminogen activator inhibitor type I and type II: INCREASE

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7
Q

Definition of anemia

First and third trimesters:

Second trimester:

A

First and third trimesters: less than 110 g/L

Second trimester:less than 105 g/L

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8
Q

Iron requirements

Normal pregnancy:
Fetus and the placenta:
Expansion of the maternal red cell mass:
Lost via excretion:

A

Normal pregnancy: 1 g
* Fetus and the placenta: 300 mg
*Expansion of the maternal red cell mass: 500 mg
*Lost via excretion: 200 mg

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9
Q

TRUE OR FALSE

There is no correlation between the hemoglobin of the fetus and that of the mother

A

TRUE

There is no correlation between the hemoglobin of the fetus and that of the mother

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10
Q

The ingestion of nonnutritive substances, is said to be more common among iron-deficient pregnant women than among other populations with iron deficiency

A

Pica

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11
Q

Folate requirements in pregnancy are roughly twice those in the nonpregnant state

A

800 mcg/day

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12
Q

Anemia related to folate deficiency most often presents in the ________ trimester and responds to folate supplementation with reticulocytosis within 24–72 hours

A

third trimester

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13
Q

Vitamin B12 (cobalamin) deficiency during pregnancy is rare, in part because deficiency of this vitamin leads to _______________

A

Infertility

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14
Q

Serum cobalamin levels are known to (rise or fall) during pregnancy.

A

fall

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15
Q

TRUE OR FALSE

Because of the changes in coagulation factor levels, D-dimer, and platelet count during pregnancy, the normal range for tests routinely used to diagnose DIC in a nonpregnant state cannot be extrapolated directly to DIC in pregnancy.

A

TRUE

Because of the changes in coagulation factor levels, D-dimer, and platelet count during pregnancy, the normal range for tests routinely used to diagnose DIC in a nonpregnant state cannot be extrapolated directly to DIC in pregnancy.

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16
Q

Complications of pregnancy that lead to DIC include

A

Placental abruption, a retained dead fetus, and amniotic fluid embolism

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17
Q

In normal women and in patients with types 1 and 2 (but not type 3) VWD, levels of factor VIII and VWF rise during pregnancy, with the most pronounced increase in the ______ trimester.

A

Third trimester

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18
Q

TRUE OR FALSE

Prophylactic administration of VWF-containing factor concentrates at delivery is necessary in patients with type 1 and type 2 VWD

A

FALSE

Prophylactic administration of VWF-containing factor concentrates at delivery is often unnecessary in patients with type 1 and type 2 VWD

However, the risk of postpartum hemorrhage is significant (13–29%) because levels fall rapidly after birth.

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19
Q

In type 1 VWD patients, factor VIII levels should be tested not only late in the third trimester but also for________weeks postpartum.

A

1–2 weeks postpartum.

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20
Q

In VWD, risk of bleeding appears to be minimal when factor VIII levels are greater than ______U/dL

A

Greater than 50 U/dL

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21
Q

Type 3 VWD patients require infusion of a plasma-derived VWF-containing concentrate at delivery

Give the dose

A

40–80 IU/kg, followed by doses of 20–40 IU/kg daily for 1 week and then tapered over the next few weeks

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22
Q

Coagulation Factor Deficiencies

Baseline factor levels should be tested at the first visit during pregnancy and again in the ________ trimester

A

third trimester

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23
Q

TRUE OR FALSE

Factor IX levels generally do not rise during pregnancy.

A

TRUE

Factor IX levels generally do not rise during pregnancy.

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24
Q

The commonest site of bleeding in newborns with severe hemophilia and has the highest potential for long-term serious sequelae.

A

Cranial hemorrhage

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25
Q

Associated with habitual hemorrhagic abortions and postpartum hemorrhage.

A

Deficiency of factor XIII

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26
Q

Recommendations for conditions such as congenital afibrinogenemia, hypofibrinogenemia, and dysfibrinogenemia

A

IV fibrinogen replacement (using cryoprecipitate or fibrinogen concentrate) to maintain a level of 60–100 mg/dL during pregnancy and for 6 weeks postpartum

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27
Q

Condition that is asymptomatic and is said to occur later in pregnancy and be less severe than ITP.

A

Gestational thrombocytopenia

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28
Q

Gestational thrombocytopenia occurs in the____________ trimesters, with platelet counts rarely falling below _______× 109/L

A

Second and third trimesters

70 × 109/L

**No past history of low platelets, except perhaps with previous pregnancies, the platelet count returns to normal after delivery, and there is no association with fetal thrombocytopenia

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29
Q

Management of ITP in pregnancy

Less than 10 × 109/L:

30–50 × 109/L without bleeding:

10–30 × 109/L in later trimesters or in the presence of bleeding:

A

Less than 10 × 109/L: YES regardless of trimester

30–50 × 109/L without bleeding: NO treatment

10–30 × 109/L in later trimesters or in the presence of bleeding: YES

30
Q

Splenectomy for ITP in pregnancy is best done in the ________ trimester if platelet counts are extremely low and unresponsive to treatment.

A

Second trimester

31
Q

Maternal platelet counts of greater than_______ × 109/L usually are safe for both vaginal and cesarean delivery.

A

50 × 109/L

32
Q

In most cases, spinal anesthesia should not be used if the platelet count is less than ______ ×109/L.

A

75 ×109/L

33
Q

Fewer than _____% of babies born to mothers with ITP have platelet counts less than 20 × 109/L

A

5%

34
Q

TRUE OR FALSE

In eclampsia and HELLP, thrombosis is more of an issue than is bleeding

A

TRUE

In eclampsia and HELLP, thrombosis is more of an issue than is bleeding

35
Q

TRUE OR FALSE

Some data suggest that maternal recovery from the HELLP syndrome is accelerated by administration of IV dexamethasone; however, a meta-analysis demonstrated no clear advantage to the use of glucocorticoids to decrease maternal or perinatal morbidity or mortality.

A

TRUE

Some data suggest that maternal recovery from the HELLP syndrome is accelerated by administration of IV dexamethasone; however, a meta-analysis demonstrated no clear advantage to the use of glucocorticoids to decrease maternal or perinatal morbidity or mortality.

36
Q

Another rare disorder that can present in the third trimester with severe liver dysfunction, but thrombocytopenia, if present, is generally mild and does not require treatment

A

Acute fatty liver of pregnancy

37
Q

Recommendations for anticoagulation among pregnat patients with paroxysmal nocturnal hemoglobinuria

A

Prophylactic or intermediate-dose low-molecular-weight heparin (LMWH) antepartum and for 6 weeks postpartum

38
Q

Factors specific to pregnancy that increase the risk of VTE

A

Obstruction of venous return by the gravid uterus, acquired prothrombotic changes in hemostatic proteins, and venous atonia caused by hormonal factors

Cesarean section (especially emergency), obesity, and increasing age

39
Q

Approximately 80% of deep vein thromboses in pregnancy occur in the

A

Iliofemoral veins on the left

40
Q

The commonest abnormalities associated with VTE in pregnancy

A

Factor V Leiden and the prothrombin gene mutation

41
Q

The initial test of choice in pregnant women suspected with VTE

A

Compression ultrasonography

42
Q

Recommended for all pregnant women when there is suspicion of pulmonary embolism

A

V/Q or CTPA

43
Q

The anticoagulant of choice because they do not cross the placenta and have a lower risk of osteoporosis and heparin-induced thrombocytopenia

A

LMWHs

44
Q

Based on the Chest guidelines, all women with prior history of VTE should be offered

A

Prophylactic or intermediate-dose LMWH for 6 weeks

45
Q

For pregnant women with a low risk of recurrence (eg, a single VTE with a transient risk factor unrelated to pregnancy or estrogen use)

A

Surveillance is recommended antepartum

46
Q

Those with higher risk for VTE

A

Prophylactic or intermediate dose LMWH before delivery

47
Q

Recommendations for those with no prior VTE

Higher risk of VTE (Factor V Leiden or prothrombin 20210 homozygotes or compound heterozygotes with a family history of VTE):

Factor V Leiden or prothrombin 20210 homozygotes or compound heterozygotes without a family history of VTE:

No personal history of VTE with any other thrombophilia and a family history of VTE:

Women with lower risk thrombophilias and no personal or family history of VTE:

A

Higher risk of VTE (Factor V Leiden or prothrombin 20210 homozygotes or compound heterozygotes with a family history of VTE): prophylactic or intermediate-dose LMWH antepartum and postpartum prophylaxis with prophylactic or intermediate-dose LMWH for 6 weeks

Factor V Leiden or prothrombin 20210 homozygotes or compound heterozygotes without a family history of VTE: postpartum prophylaxis with prophylactic or intermediate-dose LMWH for 6 weeks

No personal history of VTE with any other thrombophilia and a family history of VTE: surveillance antepartum; postpartum prophylaxis with prophylactic or intermediate-dose LMWH for 6 weeks

Women with lower risk thrombophilias and no personal or family history of VTE: surveillance antepartum and postpartum

48
Q

Patients with two or more episodes of VTE:

A

Treated throughout pregnancy and the puerperium

49
Q

Women who meet the criteria for antiphospholipid antibody syndrome

A

Antepartum prophylactic or intermediate-dose UFH or prophylactic LMWH and low-dose aspirin throughout pregnancy

50
Q

TRUE OR FALSE

Treatment of VTE in pregnancy should be with full-dose LMWH.

A

TRUE

Treatment of VTE in pregnancy should be with full-dose LMWH.

51
Q

Heparin is usually discontinued ______hours before induction; however, women deemed to be at very high risk of recurrent VTE can then receive IV heparin up to_____hours before delivery.

A

24 hours

4–6 hours

52
Q

TRUE OR FALSE

Heparins and warfarin are safe postpartum even when breastfeeding.

A

TRUE

Heparins and warfarin are safe postpartum even when breastfeeding.

For pregnant and breastfeeding women, fondaparinux and oral direct acting oral anticoagulants are relatively contraindicated.

53
Q

TRUE OR FALSE

With Hodgkin Lymphoma, neither the histology nor the outcome of patients who present during pregnancy is worse than that of other patients

A

TRUE

With Hodgkin Lymphoma, neither the histology nor the outcome of patients who present during pregnancy is worse than that of other patients

54
Q

Fetal risks of chemotherapy are greatest in the first trimester during the period of organogenesis, with _________ and ____________ carrying the largest risk.

A

Folate antagonists and antimetabolites

55
Q

In HL, in some cases, radiotherapy may be a feasible alternative in the ____________ trimesters of pregnancy

A

Second and third trimester

56
Q

In HL, if chemotherapy is indicated, it should be delayed until the _________ trimester; however, single-agent ______________ has been given in the first trimester with a low incidence of fetal abnormalities

A

Second trimester

Vinblastine

57
Q

TRUE OR FALSE

Compared with Hodgkin lymphoma, other lymphomas are less frequent in pregnancy, tend to present with a higher stage disease, and have a poorer prognosis.

A

TRUE

Compared with Hodgkin lymphoma, other lymphomas are less frequent in pregnancy, tend to present with a higher stage disease, and have a poorer prognosis.

58
Q

TRUE OR FALSE

Rituximab has not been associated with abnormalities of the newborn when given in the first, second, or third trimester

A

TRUE

Rituximab has not been associated with abnormalities of the newborn when given in the first, second, or third trimester

59
Q

Acute leukemias make up nearly ______% of the total followed by ______________, which comprises an additional 10%; chronic lymphocytic leukemia is extremely rare

A

90%

Chronic myeloid leukemia

60
Q

The anthracycline of choice in pregnant patients with AML

A

Doxorubicin

61
Q

TRUE OR FALSE

For patients who require chemotherapy postpartum, breastfeeding is recommended.

A

FALSE

For patients who require chemotherapy postpartum, breastfeeding is not recommended to avoid exposure of the newborn to cytotoxic drugs in the breast milk.

62
Q

Treatment options for pregnant women with CML

A

Interferon-α, hydroxyurea, leukapheresis, and busulfan

63
Q

When antifungal therapy is required, _______________ may be the drug of choice because there have been no reports of teratogenicity with this agent.

A

Amphotericin

64
Q

Of all the myeloproliferative neoplasms,________ has the highest proportion of affected women of childbearing age

A

ET

65
Q

In ET, if cytoreductive therapy becomes necessary, ___________ is the drug of choice

A

Interferon-α

66
Q

Patients with ET with a thrombotic episode (peripheral or placental) during pregnancy should receive

A

LMWH at therapeutic doses and oral anticoagulant therapy (PT international normalized ratio, 2–3) for at least 6 weeks postpartum

67
Q

Patients with sickle cell anemia should receive at least_______ mg of folate per day

A

1 mg of folate per day

68
Q

In Sickle cell anemia, Prophylactic transfusions are suggested in those with

A

History of severe sickle cell anemia–related complications before pregnancy or if there are additional features of high-risk pregnancy or new sickle cell anemia–related complications during pregnancy

69
Q

Patients with β-thalassemia minor generally tolerate pregnancy well; however, doses of at least________ mg/ day of folate PO

A

4 mg/ day of folate

70
Q

In thalassemia, during pregnancy, regular transfusions are recommended to keep the hemoglobin level at _______ mg/dL, and transfusion requirements often increase compared with prepregnancy values.

A

10 mg/dL

WILLIAM'S HEMATOLOGY (109 decks)

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