Anemia in Pregnancy

Question 1

What are the four parameters that we care about in iron studies?

Answer 1

Serum iron, TIBC, transferrin, and ferritin.

Question 2

Why is serum iron alone unreliable as a test for anemia?

Answer 2

Serum iron fluctuates a lot. It can change rapidly, depending on what you eat.

Question 3

What does TIBC represent?

Answer 3

Total iron binding capacity.

Question 4

Describe the idea behind TIBC.

Answer 4

It gives us a picture of generally how much hemoglobin is available to bind to free iron. If iron is low in the blood, the amount of hemoglobin there to bind any Fe in the blood is high.

Question 5

What is the idea behind ferritin?

Answer 5

It tells us how much iron is stored within the cells of the body (our iron reserve).

Question 6

What does the Ferritin and TIBC look like in iron deficiency anemia?

Answer 6

Low ferritin and high TIBC. Low transferrin, too.

Question 7

What does the Ferritin and TIBC look like in anemia of chronic disease?

Answer 7

High ferritin and low TIBC because iron stores are appropriate, but cells won’t let go of them.

Question 8

What does Trasnferrin represent?

Answer 8

It tells us how well the hemoglobin is saturated with Fe.

Question 9

What is the difference between alpha and beta thalassemia?

Answer 9

One has alpha chains of hemoglobin deleted. The other has Beta chains deleted. (Respectively)

Question 10

What are the four presentations for alpha thalassemia?

Answer 10

Asx carrier (1 alpha chain deletion), Alpha Thal trait (2 deletions), 3 deletions, and 4 deletions.

Question 11

In Alpha Thalassemia, what happens with 3 deletions of the alpha chain?

Answer 11

Can no longer use any alpha chains, so either 4 beta chains (adults in HgbH) or 4 gamma chains (infants in Barts Hgb) come together.

Question 12

What is Thalassemia major? What is the implication?

Answer 12

2 deletions of the B chain units of Hgb. There is no adult Hgb that forms. So, once fetal hemoglobin runs out, 4 months, the pt is in need of transfusions or they die.

Question 13

In Alpha Thalassemia, what happens with 4 deletions of the alpha chain?

Answer 13

Hydrops fetalis, severe heart failure in utero that leads to death of fetus before birth. They are not compatible with life.

Question 14

What is Beta Thalassemia trait?

Answer 14

1 deletion of the beta chain unit of Hgb. It is often asymptomatic anemia.

Question 15

If a caucasian pregnant lady comes to my clinic with incidental anemia, what is the next step?

Answer 15

Trial iron supplementation and have her return to clinic in three to four weeks.

Question 16

What do we do if the pregnant lady’s anemia did not improve after iron supplementation, or she comes in and is of black or south east asian decent?

Answer 16

We order an iron panel (serum iron, TIBC, Transferrin, and Ferritin), serum hgb electrophoresis (to see the a quantitative amount of each type of hgb).

Question 17

What is the Hgb level for anemia in a pregnant lady?

Answer 17

10.5

Question 18

If a pregnant lady comes in with Hgb of 8.7, serum iron low, TIBC high, transferrin normal, and Ferritin low, and an MCV that is 72, what is the cause of her anemia?

Answer 18

Iron deficiency anemia.

Question 19

If a pregnant lady comes in with Hgb of 8.7, serum iron low, TIBC normal, transferrin normal, and Ferritin normal, her hgb electrophoresis shows an increase in Hgb A2 to 2%, and an MCV that is 72, what is the cause of her anemia?

What is the next step?

Answer 19

Beta thalassemia minor, not major if had no symptoms in childhood.

The next step is to get her genetic counseling and check the B thal status of her male partner to see likelihood of baby being a carrier or having B Thal major.

Question 20

What is the inheritance pattern of Sickle Cell Disease and Beta Thalassemia?

Answer 20

Autosomal recessive.

Question 21

Someone with sickle cell disease who had multiple vaso-occlusive episodes over the years now comes in with chest pain and shortness of breath that is not relieved by nitrates and has a negative ACS workup and negative pneumonia workup. What is the cause of their chest pain?

How do we treat it?

Answer 21

Acute chest syndrome.

Fluids exchange.

Question 22

Describe G6PD deficiency.

Answer 22

RBCs lack ability to oxidize things, so they are fragile and hemolyze when exposed to certain substances.

Question 23

What are antibiotics that cause G6PD deficiency pts to present?

How do these pts present when having an episode?

Answer 23

Nitrofurantoin and Sulfonamides.

brown urine and signs of jaundice and hyperbilirubinemia and anemia (signs of hemolysis).

Question 24

List the constellation of findings in HELLP.

If HELLP is present, what is the next step?

Answer 24

Hemolysis (jaundice), Elevated Liver enzymes, Low Platelets.

Deliver the baby immediately.