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A. MLA Map Obstetrics and Gynaecology > Anaemia in Pregnancy > Flashcards

Anaemia in Pregnancy Flashcards

1
Q

What is the definition of anaemia in women?

1 - <200 g/L Haemoglobin (Hb)
2 - <160 g/L Haemoglobin (Hb)
3 - <140 g/L Haemoglobin (Hb)
4 - <120 g/L Haemoglobin (Hb)

A

4 - <120 g/L Haemoglobin (Hb)

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2
Q

In a non-pregnant woman, anaemia is defined as <120 g/L Haemoglobin (Hb). Match the cut off to the trimester in a pregnant woman with anaemia?

1st trimester (0-12 wks)
>12 weeks to birth
Immediately post birth

Hb <100 g/L
Hb <110g/L
Hb <105 g/L

A
  • 1st trimester (0-12 wks) = Hb <110g/L
  • > 12 weeks to birth = Hb <105 g/L
  • Immediately post birth = Hb <100 g/L
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3
Q

Typically what 2 timepoints do pregnant women have their FBC taken which would identify if anaemia was present?

1 - 10-12 and 28 wks
2 - 10-12 and 18 wks
3 - 16 and 28 wks
4 - 18 and 32 wks

A

1 - 10-12 and 28 wks

  • additional FBC at 20 and 40 weeks if patient is high risk
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4
Q

What is the prevalence of anaemia in the UK?

1 - 2.4%
2 - 24%
3 - 45%
4 - >60%

A

2 - 24%

Lower income countries this is 50%
due to:
- nutritional deficiencies (iron)
- infectious diseases (malaria)
- variant Hb (sickle cell disease)
- thalassaemic disorder

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5
Q

Do iron levels fall first or does anaemia occur first?

A
  • iron levels drop first
  • pregnant women can be iron deficient and have a normal Hb
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6
Q

What maternal symptoms can present in suspected anaemia in pregnancy?

1 - fatigue/weakness
2 - pallor / jaundice
3 - dizziness
4 - increased risk of infection
5 - palpitations
6 - all of the above

A

6 - all of the above

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7
Q

Anaemia can have detrimental effects on the mother. Which of the following is NOT one of these?

1 - Post partum haemorrhage
2 - Puerperal sepsis
3 - Increased mortality (< 70g/L)
4 - Myocardial infarction

A

4 - Myocardial infarction

  • increased mortality was shown in lower income countries
  • puerperal sepsis is due to a genital tract infection
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8
Q

Anaemia can have detrimental effects on the foetus. Which of the following is NOT one of these?

1 - large birth weight
2 - Pre-term birth
3 - Perinatal death
4 - neuro-developmental impairment

A

1 - large birth weight
- typically causes low birth weight

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9
Q

During pregnancy their is a physiological increase in plasma volume by what %?

1 - 3-5%
2 - 10-15%
3 - 20-30%
4 - 30-50%

A

4 - 30-50%
- referred to as dilution anaemia

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10
Q

During pregnancy their is a physiological increase in RBCnumber by what %?

1 - 2-3%
2 - 20-30%
3 - 30-40%
4 - 30-50%

A

2 - 20-30%
- RBCs increase to supply placenta and foetus

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11
Q

Does hematocrit, a % by volume of red cells in your blood increase or decrease pregnancy?

A
  • decreases
  • please increases by 30-50% and RBCs only increases by 20-30%
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12
Q

As the RBC number increases, the expecting mother requires an increase in haematinics, nutrient for RBCs development. Which of the following is NOT a haematinic?

1 - iron
2 - folic acid
3 - vit B12
4 - vitamin A
5 - vitamin D

A

4 - vitamin A
- good for eyes but not a haematinic

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13
Q

Iron is one haematinic that is required in pregnancy for erythropoiesis and iron dependent enzymes including those in foetal and placental tissue. Which trimester is this particularly important in?

1 - 1st
2 - 2nd
3 - 3rd

A

3 - 3rd
- important for growth of baby in 1st 4-6months
- Increased maternal erythropoiesis to help with this

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14
Q

What is the iron requirement in a non-pregnant women?

1 - 1-2mg/day
2 - 5-10mg/day
3 - 25-50mg/day
4 - >100mg/day

A

1 - 1-2mg/day
- typically consume 10mg/day, but only 10-15% absorbed = 1-2mg

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15
Q

What is the iron requirement in a pregnant women towards the end of pregnancy?

1 - 2mg/day
2 - 6mg/day
3 - 25mg/day
4 - 100mg/day

A

2 - 6mg/day
- mothers should be consuming aprox 27mg of iron/day

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16
Q

Does the absorption of iron capacity increase or decrease in pregnancy?

A
  • increases in pregnancy
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17
Q

In pregnancy as the demand for iron increases, which of the following forms of iron decreases first?

1 - transport iron
2 - erythropoiesis iron
3 - storage iron

A

3 - storage iron
- once iron stores are used the pregnant women becomes anaemic

18
Q

All women are at risk of pregnancy in anaemia, however, which of the following may have a greater risk of anaemia in pregnancy?

1 - nutritional (vegetarian, vegan)
2 - multiparty with short inter-pregnancy interval (<1y)
3 - socio-economic factors
4 - teenagers
5 - late antenatal support
6 - medications e.g. Anticoagulants
7 - Menorrhagia
8 - Women who decline transfusion e.g. Jehovah’s witness
9 - all of the above

A

9 - all of the above

19
Q

Our diets contain 2 forms of iron,

  • heme iron (meats) = Fe2+ iron is already bound to haemoglobin
  • non-heme iron (vegetables) = Fe3+ as not bound to haemoglobin

Once digested, all iron converted into Fe2+. Is heme or non-heme iron easier to absorb?

A
  • heme iron is absorbed better
  • this is why vegetarians and vegans are at increased risk of anaemia
19
Q

Which vitamin helps with the absorption of iron?

1 - vitamin D
2 - vitamin C
3 - vitamin A
4 - vitamin K

A

2 - vitamin C

  • tannins in tea and coffee inhibit iron absorption
20
Q

If a woman becomes iron deficient in pregnancy what should they be advised to do?

1 - increase iron in diet
2 - have iron infusions
3 - blood transfusions
4 - take iron supplements

A

4 - take iron supplements

  • ferrous sulphate or fumarte
21
Q

Increased folate is also required in pregnancy, which of the following is NOT a good source of folate?

1 - garlic
2 - green vegetables
3 - nuts / seeds / legumes
4 - citrus / mango / banana
5 - avocado
6 - eggs

A

1 - garlic

22
Q

All of the following are causes of anaemia in pregnancy, but which is the most common cause?

1 - physiological dilutional
2 - iron deficiency
3 - haematinic deficiency (folate)
4 - haemolysis, Elevated Liver Enzymes, Low platelets (HELLP syndrome)
5 - blood loss (puerperium)

A

2 - iron deficiency

Some patients may have anaemic causing conditions such as:

  • Haemoglobinopathies: Sickle cell anaemia, thalassaemia
  • Bone marrow failure
  • Haemolytic anaemias e.g. hereditary spherocytosis
23
Q

In addition to check and making sure patients iron levels are ok, what other marker associated with iron do we need to measure and consider giving if it is low?

1 - transferrin
2 - ferritin
3 - feroportin
4 - hepcidin

A

2 - ferritin
- stores iron in tissues

  • if <30ug/L may need to start oral iron supplementation
24
Q

Which of the following is NOT an instruction given to patients when advising them to take iron supplements?

1 - every morning
2 - with tea or coffee
3 - empty stomach
4 - maximum once a day

A

2 - with tea or coffee
- this can reduce iron absorption

25
Q

When giving patients oral iron, what is the target of elemental iron (iron that is available for absorption) that patients should be taking?

1 - 4-8mg
2 - 4-80mg
3 - 40-80mg
4 - 80-120mg

A

3 - 40-80mg

26
Q

Which of the following molecules negatively regulates iron absorption, and is lowest in the mornings?

1 - hepcidin
2 - ferritin
3 - vitamin D
4 - vitamin C

A

1 - hepcidin

27
Q

Which of the following is NOT a common adverse effect of oral iron supplements?

1 - constipation
2 - diarrhoea
3 - nausea
4 - dark stool

A

2 - diarrhoea

28
Q

In women who have been identified as anaemic, they should continue on oral iron supplementation throughout pregnancy and then during breast feeding for how long?

1 - whole time breastfeeding
2 - until a total of 6 weeks post-partum
3 - until they want to stop
4 - until Hb levels are above 120g/L

A

2 - until a total of 6 weeks post-partum
- may still be breastfeeding, but just stop after 6 weeks total post partum

29
Q

If a patient is iron deficient, are over the counter iron supplements sufficient to raise iron levels enough?

A
  • no
30
Q

When trying to identify if a patient is iron deficient we can look at MCV which will be microcytic anaemia (<80fl). Which 2 of the following could cause this in pregnancy?

1 - iron deficiency (reduced MCV)
2 - haemoglobinopathies (sickle cell) (reduced MCV)
3 - increased MCV

A

3 - increased MCV
- this happens in pregnancy, but in anaemia in pregnancy this is likely to go down

31
Q

In pregnancy, does mean corpuscular haemoglobin (MCH), a measurement of the amount of haemoglobin in red blood cell go up of down?

A
  • goes up
  • BUT can go down if patient is iron deficient or have haemoglobinopathies (sickle cell)
32
Q

If a patient has a low Hb (<70g/L) and are between 34-40 wks and/or are not responding to iron supplementation, who should they be referred to?

1 - GP
2 - haematologist
3 - obstetrics
4 - gynaecologist

A

3 - obstetrics

  • need to check iron compliance
33
Q

Intravenous iron can be considered in patients with iron deficiency anaemia who are not responding to iron supplements. But which trimester must they not be given?

1 - 1st
2 - 2nd
3 - 3rd

A

1 - 1st

34
Q

Intravenous iron can be considered in patients with iron deficiency anaemia who are not responding to iron supplements. Which of the following is NOT an indication for oral transfusion?

1 - Non-compliance with or intolerance of oral iron
2 - Malabsorption
4 - Patient choice
3 - rapid correction of anaemia is required e.g. Hb<70g/L or close to term

A

4 - Patient choice

  • More women achieved target Hb and maintained Hb with Fewer side effects with iron transfusion
35
Q

Intravenous iron can be considered in patients with iron deficiency anaemia who are not responding to iron supplements. Which of the following is NOT a contraindication for oral transfusion?

1 - Anaphylaxis/serious reactions
2 - Third trimester
3 - Active infection
4 - Decompensated liver disease

A

2 - Third trimester
- 1st trimester is contraindicated

Disadvantages of iron transfusion:
- Rare instances of anaphylaxis
- Hypophosphataemia
- Extravasation and skin staining
- Cost and administration

36
Q

B12 is another important haematinics for erythropoiesis. Which of the following is NOT a cause of low B12?

1 - vegan diets
2 - normal diet
3 - inflammatory bowel disease
4 - physiological effect
5 - surgery

A

2 - normal diet

  • physiological low B12 typically occur in the 3rd trimester
37
Q

Which 2 of the following are symptoms of a patient with low B12?

1 - paraesthesia neuropathy causing pins and needles)
2 - pallor
3 - macrocytosis (small TBCs)
4 - bruising

A

1 - paraesthesia neuropathy causing pins and needles)
3 - macrocytosis (small TBCs)

38
Q

If a patient has confirmed low vitamin B12, how should they be treated?

1 - iron and folic acid supplementation
2 - multivitamin over the counter
3 - hydroxycobalamin injection (IM)
4 - all of the above

A

3 - hydroxycobalamin injection (IM)
- 3 injections given
- check 2 months post natal by GP

39
Q

Pregnancy and lactation are associated with increased folate requirements, malabsorption, diet and medication can all cause low folate.

How much folate should a pregnant woman be advised to take?

1 - 400ucg daily until term
2 - 1mg daily until term
3 - 5mg daily until term
4 - 10mg daily until term

A

3 - 5mg daily until term

  • pregnant women not folate deficient take 400ucg daily until term
  • reduces the risk of neural tube defects
40
Q

Women with anaemia are at higher risk of post partum haemorrhage. What cut off of Hb, should women be advised to give birth in an obstetrician led unit?

1 - Hb <70g/L
2 - Hb <80g/L
3 - Hb <100g/L
4 - Hb <120g/L

A

3 - Hb <100g/L

Group and save and crossmatch
Active management of third stage (removal of placenta to reduce risk of PPH)

41
Q

What is the definition of post-partum anaemia?

1 - <200 g/L Haemoglobin (Hb)
2 - <160 g/L Haemoglobin (Hb)
3 - <140 g/L Haemoglobin (Hb)
4 - <100 g/L Haemoglobin (Hb)

A

4 - <100 g/L Haemoglobin (Hb)

  • give oral iron if no active bleeding
  • check FBC 48h post delivery
  • if severe symptoms give iron transfusion
  • may need blood transfusion

A. MLA Map Obstetrics and Gynaecology (29 decks)

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