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Y4 - GOSH > Anaemia in Pregnancy + Rhesus Status > Flashcards

Anaemia in Pregnancy + Rhesus Status Flashcards

1
Q

What is anaemia?

A

a low concentration of haemoglobin in the blood

  • this is the result of an underlying disease and is not a disease itself
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2
Q

What is the importance of haemoglobin?

What is important for ensuring its functioning?

A
  • it is a protein found in RBCs
  • it is responsible for picking up oxygen in the lungs and transporting it to cells
  • iron is essential for creating haemoglobin / is part of its structure
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3
Q

When are women screened for anaemia during pregnancy?

A
  • booking clinic
  • 28 weeks gestation
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4
Q

Why does anaemia occur in pregnancy?

A
  • during pregnancy, the plasma volume increases
  • this leads to a reduction in haemoglobin concentration

the blood is diluted due to an increased plasma volume

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5
Q

Why is it important to optimise treatment of anaemia during pregnancy?

A

it is important to ensure the woman has reasonable reserves in case there is significant blood loss during delivery

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6
Q

How does anaemia present?

A
  • it is often asymptomatic
  • it may present with:
    • SOB
    • pallor
    • fatigue
    • dizziness
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7
Q

What are the normal ranges for haemoglobin at booking, 28 weeks gestation and postpartum?

A

Booking:

  • Hb should be > 110 g/L

28 weeks gestation:

  • Hb should be > 105 g/L

Post-partum:

  • Hb should be > 100 g/L
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8
Q

How can the mean cell volume (MCV) be used to determine the cause of anaemia?

A

Low MCV:

  • indicates iron deficiency anaemia

Normal MCV:

  • indicates physiological anaemia due to increased plasma volume of pregnancy

Raised MCV:

  • indicates B12 or folate deficiency

(MCV = a measurement of RBC size)

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9
Q

What other routine screening is offered to women at booking clinic?

A

haemoglobinopathy screening

  • all women are offered screening for thalassaemia
  • high risk women are offered screening for sickle cell disease

(these would both cause significant anaemia during pregnancy)

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10
Q

What investigations that are NOT routinely performed may help to identify the cause of the anaemia?

A
  • ferritin
  • B12
  • folate
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11
Q

What is the management for anaemia in pregnancy?

A

iron replacement

  • typically, 200mg ferrous sulphate 3x daily
  • women who are not anaemic but have low ferritin stores may be started on supplementary iron
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12
Q

What are women with a low B12 in pregnancy tested for?

A

pernicious anaemia

  • this involves testing for intrinsic factor antibodies
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13
Q

How does pernicious anaemia occur?

A
  • autoimmune condition in which autoantibodies attack parietal cells that make intrinsic factor
  • intrinsic factor is needed for the absorption of vitamin B12 in the gut
  • malabsorption of B12 means that not enough RBCs are made

(can also occur due to conditions affecting the stomach / small intestine that reduce absorption of B12)

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14
Q

What are the treatment options for low B12?

A
  • IM hydroxycobalamin injections
  • oral cyanocobalamin tablets
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15
Q

What is the management for women with folate deficiency?

A
  • all women should be taking 400mcg folic acid daily
  • this is increased to 5mg if there is folate deficiency
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16
Q

How is thalassaemia / sickle cell disease managed in pregnancy?

A
  • high dose folic acid (5mg)
  • close monitoring / regular transfusions when required
17
Q

What Rhesus status means no further treatment is required in pregnancy?

A

Rhesus-D positive

  • if the mother is Rh-D positive, no additional treatment is needed
18
Q

What happens if a rhesus-D negative woman becomes pregnant with a rhesus-D positive fetus?

A
  • at some point during the pregnancy, the blood from the baby will enter the mother’s bloodstream
  • the RBCs of the fetus display the Rh-D antigen
  • the mother’s immune system produces antibodies against the Rh-D antigen
  • the mother has now become sensitised to the Rh-D antigen
19
Q

What happens if a rhesus-D negative woman becomes pregnant with a rhesus-D positive fetus?

A
  • at some point during the pregnancy, the blood from the baby will enter the mother’s bloodstream
  • the RBCs of the fetus display the Rh-D antigen
  • the mother’s immune system produces antibodies against the Rh-D antigen
  • the mother has now become sensitised to the Rh-D antigen
20
Q

What issues are caused by Rhesus sensitisation in a first pregnancy?

A

sensitisation does NOT cause problems in a first pregnancy

21
Q

What is the issue that arises from Rhesus sensitisation in subsequent pregnancies?

A
  • the woman now has antibodies against the Rh-antigen
  • if the second fetus is Rh positive, the antibodies cross the placenta
  • the antibodies attach to the fetal RBCs and cause the fetal immune system to destroy them
  • this results in haemolytic disease of the newborn
22
Q

What is involved in the management of Rhesus incompatibility?

A
  • management is aimed at preventing sensitisation
  • intramuscular anti-D injections are given the Rh-negative women
  • once sensitisation has occurred, there is no way of reversing it
23
Q

How do the anti-D injections work?

A
  • the anti-D attaches to the rhesus D antigens of the fetal RBCs within the maternal circulation
  • this causes them to be destroyed
  • as the fetal RBCs are destroyed, this prevents the mother’s immune system from recognising the Rh-D antigen and creating antibodies against it
24
Q

When are anti-D injections given?

A

Routine injections:

  • 28 weeks gestation
  • during birth (if blood group of fetus is Rh+)

Additional injections given at any time sensitisation may occur:

  • antepartum haemorrhage
  • amniocentesis
  • abdominal trauma
25
Q

When should anti-D be given when a sensitisation event occurs?

A

Anti-D must be given within 72 hours of a sensitisation event

26
Q

What test is performed to determine whether further anti-D is required?

A

Kleihauer test

27
Q

Why and when is the Kleihauer test performed?

A
  • it assesses how much fetal blood has passed into the mother’s blood during a sensitisation event
  • it is used to assess any event after 20 weeks gestation
  • it assesses whether further doses of anti-D are required
28
Q

How does the Kleihauer test work?

A
  • acid is added to a sample of the mother’s blood
  • fetal haemoglobin is more resistant to acid
  • fetal Hb persists in response to the acid, whereas the mother’s Hb is destroyed
  • the number of cells still containing Hb (fetal cells) can then be calculated

Y4 - GOSH (62 decks)

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